Value of diagnostic upper endoscopy preceding percutaneous gastrostomy

Percutaneous gastrostomies, placed endoscopically or radiographically, have supplanted their surgical counterparts in many institutions. Although there are few comparative data, a cost advantage is claimed for the radiographic method, as no endoscopy is required. We performed upper endoscopy on 201 patients prior to attempted percutaneous endoscopic gastrostomy (PEG). The medical records of these patients were reviewed. Data collected included endoscopic findings which precluded gastrostomy, necessitated conversion to jejunostomy, or led to changes in medical management. For a total of 73 patients (36%), findings at pregastrostomy endoscopy led to major changes in medical management, including 35 patients with severe reflux esophagitis, 29 patients with peptic ulcers, and two patients with gastric outlet obstruction. Appropriate treatment of such conditions may improve morbidity, mortality, and cost by reducing length of hospital stay. The authors recommend diagnostic upper endoscopy in patients undergoing percutaneous gastrostomy, regardless of placement method.