Prevention and management of major complications in percutaneous endoscopic gastrostomy

BACKGROUND: Percutaneous endoscopic gastrostomy is a commonly used endoscopic technique where a tube is placed through the abdominal wall mainly to administer fluids, drugs and/or enteral nutrition. Several placement techniques are described in the literature with the ‘pull’ technique (Ponsky-Gardener) as the most popular one. Independent of the method used, placement includes a ‘blind’ perforation of the stomach through a small acute surgical abdominal wound. It is a generally safe technique with only few major complications. Nevertheless these complications can be sometimes life-threatening or generate serious morbidity. METHOD: A narrative review of the literature of major complications in percutaneous endoscopic gastrostomy. RESULTS: This review was written from a clinical viewpoint focusing on prevention and management of major complications and documented scientific evidence with real cases from more than 20 years of clinical practice. CONCLUSIONS: Major complications are rare but prevention, early recognition and popper management are important.