Percutaneous Endoscopic Gastrostomy (PEG) Placement in the Overweight and Obese Patient

Abstract

Background: Traditionally, percutaneous endoscopic gastrostomy (PEG) placement in the obese patient has been considered a relative contraindication due to the impedance of gastric transillumination and inability to approximate the abdominal and gastric wall. The aim of this study was to determine the overall success rate, morbidity, and PEG-related mortality in overweight and obese patients. Methods: Three hundred fifty-five consecutive patients were retrospectively evaluated over a 1-year period at the Virginia Commonwealth University Medical Center for postprocedure-related PEG and PEG/jejunostomy (J) complications. One hundred thirty-four patients were considered overweight (body mass index [BMI] ≥27 kg/m²). Of those, 80 patients were found to be obese (BMI ≥30 kg/m²) with a BMI ranging 30–63 kg/m². Results: Gastrostomy placement was successful in 130 of 134 (97%) overweight patients (p < .05). The overall procedure-related mortality was 0%. The rate of significant complications in overweight and obese patients remained 0% when compared with those patients with a normal BMI. Out of 355 patients, 14 failed to receive a PEG; 3 of these were obese and 1 was overweight. These 4 procedures were aborted due to a paucity of anatomical landmarks and failure to transilluminate the abdominal wall. Conclusions: We believe that PEG placement in the overweight and obese patient can be a technically safe procedure according to our success rate of 100%, with a procedure-related mortality rate of 0%. In those overweight and obese patients who require specialized long-term enteral nutrition support, PEG placement should be considered earlier and more frequently.

Many physicians have considered obesity a relative or even absolute contraindication to placement of a percutaneous endoscopic gastrostomy (PEG). This retrospective review of our center’s experience over a 1-year period shows that PEG placement is possible and safe, especially at a center that performs a high volume of PEG procedures.

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