PEG Placement by a Single Physician

Dear Sir,

We read with some surprise the paper by Rimon entitled “The safety and feasibility of percutaneous endoscopic gastrostomy placement by a single physician” [1]. Probably the main point of this report is to state that percutaneous endoscopy gastrostomy can be done safely by a single physician in case of necessity. However, percutaneous endoscopy gastrostomy is very rarely done as an emergency procedure. Therefore it is questionable whether performance of such a procedure by a single endoscopist could be considered to be a normal clinical practice.

We wonder whether the study was approved by an ethics committee, whether patients gave written informed consent having been informed that the procedure was to be done by a single endoscopist rather than two physicians, while “the second gastroenterologist is available in an adjacent room for case of emergency” and last but not least, whether the assistant nurse is approved to perform part of therapeutic endoscopy in Israel.

In the description of the procedure, no information is given about whether a sterile endoscope was used (probably not as no sterile plastic cover is shown in the picture). The working part of the endoscope (probably non sterile) goes through the sterile area of percutaneous gastrostomy as shown in Figure 1 of the paper. The physician's right hand was considered to be sterile during the whole procedure although the free uncovered skin of his wrists is seen in this figure.

We agree only with the author's statement that the approach described should be performed by a single gastroenterologist only when two physicians are not available. We would add furthermore and only in the exceptional case where life is threatened. We think that in any other circumstances, operation by a single physician is not good clinical practice, regardless of whether the hospital is a university one.

Reference

• 1 Rimon E. The safety and feasibility of percutaneous endoscopic gastrostomy placement by a single physician.  Endoscopy. 2001;  33 241-244