Percutaneous endoscopic gastrostomy. Do surgeons and gastroenterologists get the same results?

Numerous investigators have reported the safety, cost effectiveness, and low morbidity and mortality of percutaneous endoscopic gastrostomy (PEG) but not studies compare the results of gastroenterologists and surgeons performing PEG. In a retrospective review of PEG performed at our institution, morbidity and mortality were compared between these two groups. The procedure was performed by either the surgical service (n = 49) or gastroenterology service (n = 51). One hundred PEGs were successfully placed in 92 patients. Three placement failures occurred in the gastroenterology group. Major complications were defined as conditions requiring operative intervention or resulting in death. Minor complications, using a defined list (13 different complications), were those not serious or life-threatening, which were managed medically or resolved without treatment. Twenty-nine minor (17 patients) complications and 3 major (3 patients) complications occurred in the gastroenterology group. Thirteen minor (11 patients) complications and 4 major (4 patients) complications occurred in the surgery group. Overall 30-day mortality was 14 per cent (13 patients), two of which were probably procedure-related in the gastroenterology group. In both groups, there was no difference in the numbers of patients who had complications (P greater than 0.05). The complication rate (numbers of complications/number of patients) doubled in the gastroenterology group compared with the surgery group for minor (P less than 0.04) and total complications (minor and major--P less than 0.06). Since PEG is a procedure frequently performed by gastroenterologists, it is imperative that surgeons, particularly those not performing endoscopy, be aware of the potential morbidity associated with PEG.