Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy?

Table 1 Basic considerations for percutaneous endoscopic gastrostomy implantation and typical access types

Basic considerations for PEG implantation
Is oral nutrition - for whatever reason - so inadequate that intervention is justified?
Is enteral nutrition likely to be necessary for at least 3 wk?
Is the intestine distal to the access path functional?
Are risk factors for complications absent?
Is the anatomy suitable for PEG?
Is compliance sufficient for PEG handling (feeding in (half) upright position, infection prophylaxis, mobilization of the PEG tube, etc.)?
Typical access types
Pull-PEG (Ponsky-Gauderer)	After diaphanoscopy, primary puncture with a trocar followed by pulling the tube with a thread through the esophagus
Push-/Introducer-PEG (Russell)	With diaphanoscopy, primary gastropexy followed by direct introduction of a balloon-fixed tube

PEG: Percutaneous endoscopic gastrostomy.