Percutaneous Endoscopic Gastrostomy was first performed in 1979 and appeared first in the literature in 1980. Since that time the technique has become the standard for performance of feeding gastrostomy. Presently, PEG remains one of the most frequent indications for the performance of upper endoscopy.

The original description of PEG involved the use of what has come to be known as the “Pull” technique, in which, after securing a suture via an endoscopically guided gastric puncture, the gastrostomy tube is pulled down through the mouth and esophagus and out of the abdominal wall. This remains a very popular method.

The complications associated with the performance of percutaneous gastrostomy occur with a low frequency . Infection of the abdominal wall has been minimized with the use of pre-operative antibiotics and avoidance of tension between the outer crossbar and abdominal wall. Gastrocolic fistula continues to occur with a low incidence but may be avoided in most cases by use of the “safe tract” method of site selection for puncture. Enlargement of the stoma with subsequent peri-tubal leakage may occur and may be a result of excessive tension on the tube or tube motion.

The indications for the performance of PEG and the adaptations of the technique have increased the years. In addition to providing a means for gastric feeding and decompression, the method has been used to provide access for jejunal feedings, either as an extension of PEG or by direct jejunal puncture. PEG has been used to reduce and hold paraesophageal hernia in the abdomen, as a means of gastric access for intra-gastric surgery, and to straighten sigmoid volvulus. The ethical debates associated with the placement of PEG have in some cases drawn worldwide attention. The criteria for patient selection must be closely examined.