Percutaneous endoscopic gastrostomy. A mandate for complete diagnostic upper endoscopy.

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Procedures

Background:

• Percutaneous endoscopic gastrostomy (PEG) is a common procedure for nutritional support.
• The extent of upper endoscopy performed during PEG placement varies.
• The diagnostic yield of a complete examination during PEG is not well-established.

Purpose of the Study:

• To retrospectively review cases of PEG placement.
• To determine the necessity and diagnostic value of a complete upper endoscopy during PEG.
• To identify pathologic findings during these procedures.

Main Methods:

• Retrospective review of 100 patients undergoing PEG placement between 1984 and 1988.
• Analysis of the completeness of the endoscopic examination (esophagus, stomach, duodenum).
• Documentation and categorization of all pathologic findings.

Main Results:

• 97% of PEG procedures were successful.
• 89% of cases involved a complete examination of the upper gastrointestinal tract.
• Pathologic findings were identified in 59% of patients, most commonly in the esophagus (23%) and stomach (27%).
• Peptic ulcer disease was present in 22% of patients.
• Incidental findings included gastric outlet obstruction (5%) and duodenal ulcers (8%).

Conclusions:

• A complete esophagogastroduodenoscopy (EGD) during PEG placement is essential for identifying significant pathology.
• These findings often necessitate changes in patient management and medication.
• Undiagnosed pathology is a more likely cause of postoperative complications than the PEG procedure itself.
• Routine complete EGD is mandated for all PEG procedures.