title: Percutaneous endoscopic gastrostomy in the supermorbidly obese patient.
abstract: BACKGROUND
  Obesity is reaching epidemic proportions in the United States, and as patients at the extremes of morbid obesity come under the care of surgeons, routine procedures may become increasingly complex in the face of greater body mass. We prospectively evaluated the success rate of percutaneous endoscopic gastrostomy (PEG) placement in a group of morbidly obese patients outside the current classification systems used to stratify obesity.
  
  
  METHODS
  Patients with a body mass index (BMI) greater than 60 kg/m2 who presented for PEG over a one year period were prospectively enrolled. Each patient underwent attempted PEG placement using the pull method by a single surgeon. Outcome variables included: successful PEG, wound infection, tube dislodgement, or bleeding.
  
  
  RESULTS
  Six patients with BMI > 60 kg/m2 presented for PEG. All patients were in a surgical critical care unit maintained on mechanical ventilation. All underwent successful PEG placement with standard techniques and sustained no post-procedural complications.
  
  
  CONCLUSIONS
  In the hands of an experienced surgical endoscopist, percutaneous endoscopic gastrostomy can be safely performed in patients at the extremes of morbid obesity. Future studies are warranted to validate the results of our small series.
authors.affiliation: Division of Clinical and Outcomes Research, The R. Adams Cowley Shock Trauma Center and University of Maryland School of Medicine, Department of Surgery, Baltimore, Maryland, USA. gbochicchio@umm.edu
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.forename: James L
authors.initials: JL
authors.lastname: Guzzo
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Scalea
mesh_terms: D000328:Adult; D015992:Body Mass Index; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D020699:Gastroscopes; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications*; D011183:Postoperative Complications; D011446:Prospective Studies; D016896:Treatment Outcome