Prevention and management of complications of percutaneous endoscopic gastrostomy (PEG) tubes

66 INTRODUCTION Since its introduction in 1980 (1), the use of percutaneous endoscopic gastrostomy (PEG) tubes has increased exponentially. While an estimated 61,000 PEG tubes were placed in 1988, an estimated 216,000 are performed annually today, making PEG placement the second most common indication for endoscopy of the upper gastrointestinal tract (2). Up to 10% of nursing home residents and as many as 1.7% of Medicare patients over the age of 85 years undergo gastrostomy (3). As data demonstrating the benefits of enteral over parenteral nutrition mounts, and our elderly population grows, we can expect the use of PEG tubes to continue to rise. However, the placement of a PEG tube is not without its risks. The overall complication rate has remained stable over the last 15-20 years, ranging from 4% to 23.8% of cases (4–7). Three to 4% of all cases are affected by major complications, i.e. those that are life threatening and/or require surgical intervention or hospitalization (Table 1) (4,6,8). The more common minor complications occur in between 7.4% and 20.0% of cases (Table 2) (4,6,9). Prevention and Management of Complications of Percutaneous Endoscopic Gastrostomy (PEG) Tubes NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #22