I read with interest the article by Milanchi and Allins11 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.22 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...

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