I read with interest the article by Milanchi and Allins1 on early pneumoperitoneum after percutaneous endoscopic gastrostomy (PEG) as a predictor of possible bowel injury. The authors conclude that post-procedure radiography is essential. Although that is the ideal practice, it is neither practical nor cost-effective. In their study, Milanchi and Allins found only 1 significant (<1%) event (gastrocolic fistula) that required surgery. The pneumoperitoneum in this case should have been clinically evident based on the imaging shown.

The remaining 3 patients had transient self-limiting pneumoperitoneum. My colleagues and I recently reported our own experience with PEG.2 Our patients were examined daily for at least 3 days and we did not encounter any clinically evident pneumoperitoneum or bowel injury. The main complications were wound infections. We routinely give grace periods for patients to recover while they remain on nasogastric feeding and we do not routinely place PEG while patients...

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