Limitations of percutaneous endoscopic gastrostomy in facilitating enteralnutrition in children: Review of the shortcomings of a new technique

Percutaneous endoscopic gastrostomy (PEG) insertion became the preferred te chnique for facilitating enteral nutrition in children unable to take adequ ate caloric intake orally once its advantages over the standard Stamm gastr ostomy became apparent. It has taken longer for some of its limitations and shortcomings to be recognized. Problems encountered during PEG insertion i nclude: inability to enter the stomach with the trocar, oesophageal lacerat ion, colonic perforation, gastrocolo-cutaneous fistula, peritonitis, subcut aneous emphysema, external migration of inner flange, wound infection, peri stomal excoriation. symptomatic gastro-oesophageal reflux requiring later f undoplication, intestinal obstruction and haemorrhage. Many of these compli cations can be avoided by attention to technique.