The safety and feasibility of percutaneous endoscopic gastrostomy placement by a single physician

Abstract

Background and study aims: Percutaneous endoscopic gastrostomy (PEG) has become the procedure of choice for enteral feeding. However, the procedure usually requires two physicians, which makes it more difficult to schedule than procedures performed by a single physician. We investigated whether PEG insertion by a single physician could be done with the same safety and feasibility as by two physicians.

Patients and methods: This study involved 339 consecutive patients who were referred for PEG. The same single physician, together with a nurse, performed the procedure in all patients, instead of the usual procedure performed by two physicians. Followed up of the patients for 1 month after the procedure was done.

Results: Minor complications occurred in 35 patients (10.3%), most frequently self-extubation and skin irritation. Eight patients (2.4%) had severe complications, including apnea in two, and wound infection that needed systemic antibiotics in another three patients. Three patients needed surgery because of peritonitis as a consequence of the procedure. There was no mortality in the first 48 hours after the procedure and only one patient death could be attributed to the procedure.

Conclusions: The insertion of PEG by a single experienced physician is as safe as that described in the literature with two physicians. This should not replace the traditional approach with two physicians, but should be reserved for special situations when only one physician is available.