[Percutaneous endoscopic gastrostomy (PEG)]

Percutaneous endoscopic gastrostomy (PEG), although a standard method for long-time enteral nutrition, still leaves uncertainty about details in indication, technique and complications. Based on own experiences (approximately 1000 PEG's and 170 EPJ's in the last 10 years) these topics are discussed. As new indications the PEG for decompression in chronic intestinal obstruction and the questionable relative contraindications ascites, peritoneal carcinosis and Morbus Crohn are discussed. The common thread-pull through-technique is recommended in a slightly modified variation, according to direct puncture techniques of small intestine: the cannulas inserted in the intestine are fixed by an endoscopic alligator forceps, thus facilitating precise puncture and raising safety for the patient due to avoidance of dislocation. As complications local infections, implantation metastases and the buried bumper syndrome have to be mentioned and avoided. Alternative methods for PEG and different exchange systems for more comfort for the patients are discussed finally.