Percutaneous endoscopic gastrostomy. A mandate for complete diagnostic upper endoscopy.

One hundred patients underwent upper endoscopy for the placement of percutaneous endoscopic gastrostomies (PEGS) during a four year period from 1984 to 1988. These cases were retrospectively reviewed to document the need for total endoscopy during PEG. Ninety-seven per cent of the procedures were successful. In 89 per cent, a complete exam of the esophagus, stomach, and duodenum was performed, revealing pathologic findings in 59 per cent. The most common abnormalities were in the esophagus (23%) and the stomach (27%); however, a portion of the findings were also present in the duodenum (12%) and the pylorus (11%). Additional findings present in the complete esophagogastroduodenoscopy (EGD) done at the time of PEG included a five per cent incidence of gastric outlet obstruction and antral ulcers or polyps in six per cent. The breakdown of findings in the duodenum included eight per cent incidence of duodenal ulcers and four per cent incidence of duodenitis. A total of 22 per cent of the patients had some evidence of peptic ulcer disease. Many of the cases in which pathology was found required a change in medications and, when postoperative bleeding occurred after PEG, the other pathologic entity was much more likely to be the cause of the complication than the PEG. A careful and complete EGD is mandated every time a patient is scheduled for PEG.