Emergency surgery for complications related to percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is used to restore enteral nutrition in patients with inadequate oral intake. Because of its minimally invasive nature complications are thought to be rare. We analyzed data on all patients treated for PEG-related complications at the Department of General, Visceral, and Oncologic Surgery at the Klinikum Bremen-Mitte, Germany, between 2005 and 2008. A total of 38 patients with complications required surgical evaluation. Emergency laparotomy was performed for leakage in 16 patients, for a misplaced or dislodged PEG tube in nine patients, for buried bumper with accompanying signs of peritonitis in four patients and for gastrocutaneous fistula in one patient. Eight complications were managed conservatively. Early complications within 10 days (60 %) were related to leakage or mispositioning of the PEG, while PEG device migration and fistula formation represented late complications. Hospital mortality was 17 % with the underlying disease contributing significantly to the fatal outcome. Most PEG-associated major complications were related to technical errors and carried a high mortality.