Percutaneous endoscopic gastrostomy (PEG) is the standard method for long-term enteral nutrition, yet procedure-related complications may occur. This study aimed to determine the incidence of early complications and identify associated risk factors.

We conducted a 10-year retrospective monocentric study (January 2015–March 2024) including 178 consecutive patients who underwent PEG placement using the “pull” technique. Demographic characteristics, indications, procedural parameters, and early complications (≤30 days) were recorded. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of complications.

The study included 178 patients (mean age 46.5 years; range 5–88) with a male-to-female ratio of 1.7. Most patients (≈80%, n=142) were referred from intensive care units. The main indication was severe neurological impairment (≈86%, n=153), predominantly traumatic brain injury (≈53%, n=94) and stroke (≈16%, n=28). Procedural success was achieved in 99.4% of cases (177/178). Difficult endoscopic transillumination occurred in ≈13% (n=23).The overall early complication rate was ≈8% (n=15). Complications included abdominal wall infections (n=6; 3.4%), bleeding events (n=5; 2.8%—2 hemoperitoneums and 3 minor gastrointestinal bleeds), and one perforation-related peritonitis (0.6%).In univariate analysis, prior abdominal surgery (p=0.004), abnormal abdominal wall thickness (p=0.001), pre-procedural sepsis (p=0.008), and difficult transillumination (p<0.001) were significantly associated with early complications.On multivariate regression, pre-procedural sepsis remained the only independent predictor (p=0.001).

PEG is a safe and effective procedure with a low rate of early complications. Pre-procedural sepsis represents the principal independent risk factor for adverse events. Careful pre-procedural evaluation, particularly of infectious status and abdominal wall characteristics, is essential to optimize patient outcomes.