Percutaneous endoscopic gastrostomy: indications, limitations, techniques, and results

Percutaneous endoscopic gastrostomy was introduced in 1980 as an alternative to traditional operative methods for the creation of a feeding gastrostomy. The indications for the procedure are essentially the same as those for traditional gastrostomy and include the inability to swallow secondary to neurological impairment, oropharyngeal neoplasms, and facial trauma. The method is contraindicated in the presence of massive ascites, total esophageal obstruction, coagulation disorders, and sepsis. Several variations on the original technique have been developed, and results with each are comparable. The morbidity and mortality with percutaneous methods has been at least as good as those reported for operative techniques while the cost has been lower and patient acceptance high. In spite of the ease with which gastrostomy may be performed by the percutaneous method, patient selection must be appropriate and details of technique closely followed if results are to remain acceptable.