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Percutaneous endoscopic gastrostomy and the evolution of contemporary long-term enteral access.

This paper is based on the opening lecture of the 23rd Congress of the European Society of Parenteral and Enteral Nutrition (ESPEN), given on September 9, 200l in Muenchen, Germany. The article relates the story of the origin and the evolution of the percutaneous endoscopic gastrostomy or PEG, based on the then-novel concept of sutureless approximation of a hollow viscus to the abdominal wall. It also provides a perspective of the clinical applications of PEG, in general, and the author's pediatric experience in particular. Additionally, it briefly describes the old and new expanded applications of the PEG concept. In this communication, the author of the procedure encourages young investigators to ask relevant questions in research and in clinical settings aimed at developing new ideas and concepts in the field of nutrition. He also stresses the need to carefully reflect upon the ethical and moral implications of new discoveries. The article contains pertinent illustrations and bibliographic references.