Nutritional support via percutaneous endoscopic gastrostomy.

Nutritional support is often an integral part of patient management. There are three principal access routes used for nutrient delivery: oral, enteral (tube feeding) and parenteral. Tube feeding is indicated for those patients who, in the presence of a functional gastrointestinal tract, cannot, should not or will not consume adequate nutrition orally. A number of different routes may be used in administering enteral feeds, which include nasogastric (NG), nasojejunal and enterostomy (e.g. percutaneous endoscopic gastrostomy (PEG)) methods. PEG feeding is the main topic of the present review. The concept of nutritional support via gastrostomy was first proposed by a Norwegian surgeon, Egeberg, in 1837 and first performed on the animal model by Sedillot in 1839. In 1876, Verneuil successfully performed a surgical gastrostomy in man. It was the advent of the flexible endoscope a century later that enabled the percutaneous endoscopic technique to be developed. This was first described and performed by Guaderer and Ponsky late in 1979 (Lo & Dornbrand, 1989).