Percutaneous Endoscopic Gastrostomy Placement Without Skin Incision: Results of a Randomized Trial

Abstract

Background: During percutaneous endoscopic gastrostomy (PEG) placement, skin incision is performed as standard practice. We suspected that this time-honored principle is unnecessary. Methods: In a prospective, randomized trial, 50 adults undergoing PEG placement were randomized to skin incision omission PEG (IOPEG) and standard PEG (SPEG). Two- and 7-day PEG site evaluations were performed to grade stomal infection, bleeding, pain, and overall satisfaction using a standardized scoring system. Median stomal evaluation scores were compared between groups using a Wilcoxon rank-sum test. Completion rates were compared using a t-test. Results: Placement success for the IOPEG and SPEG technique was 22/25 (88%) and 24/25 (96%), respectively (p = NS). Three failed IOPEG attempts required an incision to complete due to increased pull force encountered. One SPEG failed due to inability to transilluminate. Stomal evaluation scores of infection, bleeding, pain, leakage, and patient satisfaction were not significantly different at 2 or 7 days. No serious complications occurred as a result of skin incision omission. Conclusions: Omitting the skin incision does not significantly alter the placement success rate, patient satisfaction, or the rate of stomal complications, thus dispelling the dogma that a skin incision is mandatory for PEG placement and the myth that incisions reduce infectious complications.

While some authors recommend a skin incision at least 1 cm (or larger) during PEG placement, it may be safely and successfully performed without a skin incision. Omitting the skin incision may allow anticoagulation to be instituted earlier after PEG placement. Larger skin incisions may not reduce local complications of PEG placement.