Percutaneous endoscopic gastrostomy placement without a skin incision: results of a prospective pilot study.

Percutaneous endoscopic gastrostomy (PEG) tube placement may result in substantial skin site complications. Standard PEG (SPEG) placement involves performing a skin incision, which in our experience is not necessary. In a prospective pilot study, we examined the need for this incision with respect to placement success and stomal complications. Twenty consecutive patients underwent 20 Fr PEG tube placement by a modified technique, involving skin incision omission (IOPEG). Stoma evaluations were performed at 2 and 7 days after placement to record infection and bleeding scores. Mean infection scores were compared with published historical SPEG data obtained from this institution using the identical scoring system. In 12 cases, a digital force gauge measured peak pull-forces (pounds) required to pull the IOPEG through the abdominal wall and were compared with published SPEG pull-force data. Successful IOPEG placement was achieved in 20/20 (100%). No infectious or bleeding complications occurred. Mean 2 and 7-day infection scores were significantly lower than historical SPEG scores. Mean pull-forces were greater than published SPEG forces. A skin incision is not required for successful PEG placement. Incision omission likely increases PEG pull-forces, but may possibly lead to reduced infection complications.