pp250-5), is of particular relevance to us here, at the Royal Hospital for Neuro-disability, since we have more than 100 patients with permanent or semipermanent gastrostomies (age range 18 to 65). Whilst we acknowledge that most PEGs are placed in the elderly and in patients with cerebrovascular disease (with a relatively poor prognosis), there is also an increasing prevalence of young people with severe acquired brain injury who live for many years, fed partly or exclusively through

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... ies. At this hospital, protocols are in place covering gastrostomy indications and management. Close liaison and a joint PEG placement protocol with a local gastroenterology unit, highly skilled in PEG insertions, makes for fewer complications. Each gastrostomy is closely monitored by nurses and supervised by dietitians. Threemonthly auditing of gastrostomy sites over 3 years, showed 78% had no significant problems (57% clear dry sites, 21% slight redness with or without minor serous discharge). Amongst the remainder, complications included granulation, inflammation, serous, purulent or bloodstained discharges. Only 2% had hypergranulated infected sites. However, no tubes required removal and even the worst sites did not appear to cause distress to patients. Moderate site complications were