Percutaneous endoscopic gastrostomy placement without skin incision: results of a randomized trial.
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.
Sedlack
Robert E
RE
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Pochron
Nichole L
NL
Baron
Todd H
TH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D062109:Dermatologic Surgical Procedures; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006470:Hemorrhage / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012867:Skin / Q000473:pathology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D013997:Time Factors