This method is widely accepted for providing long-term enteral nutrition or gastric decompression, and is considered safe routine method. However, there are certain circumstances that complicate PEG placement. The aim of this discussion should be to review what evidence exists in these high risk scenarios and attempt to provide guidelines for PEG placement in high-risk patients.
I tend to prefer radiologically inserted gastrostomy (RIG) in higher risk patients, but a recent paper [Predictive factors for early mortality after percutaneous endoscopic and radiologically-inserted gastrostomy Dig Dis Sci. 2013 Dec;58(12):3558-65 by Laskaratos et al] suggests this may not be appropriate. Conclusion > 'The overall 30-day mortality was 11% in the PEG and 40% in the RIG group. The multivariate regression analysis suggested that cardiovascular co-morbidities and RIG insertion were independent risk factors for early mortality.'
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