does not reduce suffering, it may cause fluid overload, diarrhea, abdominal pain and local complications, and it can reduce the amount of human interaction the patient experiences. Complications Surgical site infection around the gastrostomy site. Administration of intravenous antibiotics can reduce infection around the gastrostomy site. Prophylaxis with co-amoxiclav decreases the proportion of people developing MRSA infections compared with no antibiotic prophylaxis (in people without cancer) undergoing percutaneous endoscopic gastrostomy insertion. Hemorrhage Gastric ulcer either at the site of the button or on the opposite wall of the stomach ("kissing ulcer") Perforation of bowel (most commonly transverse colon) leading to peritonitis Puncture of the left lobe of the liver leading to liver capsule pain Gastrocolic fistula: this may be suspected if diarrhea appears a short time after feeding. In this case, the feed goes direct from stomach to colon (usually transverse colon) Gastric separation "Buried bumper syndrome" (the gastric part of the tube migrates into the gastric wall) Removal of PEG tubes Indications PEG tube no longer required (recovery of swallow after stroke or brain trauma, or after surgery or radiotherapy for head and neck cancer) Persistent infection of PEG site Failure, breakage or deterioration of PEG tube (a new tube can be sited along the existing track) "Buried bumper syndrome" Techniques PEG tubes with rigid, fixed "bumpers" are removed endoscopically. The PEG tube is pushed into the stomach so that part of the tube is visible behind the bumper. An endoscopy snare is then passed through the endoscope, and passed over the bumper so that the tube adjacent to the bumper is grasped. The external part of the tube is then cut, and the tube is withdrawn into the stomach, and then pulled up into the esophagus and removed through the mouth. The PEG site heals without intervention. PEG tubes with a collapsible or deflatable bumper can be removed using traction (simply by pulling the PEG tube out through the abdominal wall). History The first percutaneous endoscopic gastrostomy performed on a child was on June 12, 1979, at the Rainbow Babies & Children's Hospital, University Hospitals of Cleveland. Dr. Michael W.L. Gauderer, pediatric surgeon, Dr. Jeffrey Ponsky, endoscopist, and Dr. James Bekeny, surgical resident, performed the procedure on a -month-old child with inadequate oral intake. The authors of the technique, Dr. Michael W.L. Gauderer and Dr. Jeffrey Ponsky, first published the technique in 1980. In 2001, the details of