Percutaneous endoscopic gastrostomy: avoiding complications.

This study evaluates our complications arising directly or indirectly from placement or management of percutaneous endoscopic gastrostomy (PEG) tubes and provides recommendations for avoidance of complications. Seventy-one patients received PEG tube placement by otolaryngologists between January 1991 and May 1997. Records were reviewed for diagnoses, combined procedures, and complications. Addressing potential causes of complications prompted modification of our technique of PEG tube placement and management. Twenty-three patients received PEG for dysphagia/aspiration unrelated to neoplasia, 11 received PEG with staging endoscopy, 11 received PEG after treatment for head and neck neoplasm, and 26 received PEG at the time of primary resection. Major complications included retained PEG hub and delayed colon abscess ultimately resulting in death. Minor complications included skin abscesses, cellulitis, and early and late vasovagal response with PEG tube removal. An airway emergency, on attempted oral airway intubation, resulted in an aborted PEG attempt and constituted another complication outside the 4 groups stated above. The major complication was not found within a literature review. We have modified our management for avoidance of this complication. We believe the causes of the minor complications have been identified, and with additional modifications in our technique, we have not had any similar complications recently. The recommended techniques are discussed in detail.