Reply to Drs Rejchrt and Bureš

Dear Sir,

I thank Drs Rejchrt and Bureš for their comment and their interest in my article. I agree with their view that percutaneous endoscopic gastrostomy is rarely an emergency procedure. The study was not approved by an ethics committee, as the procedure was performed employing the same technique that is used in most of the gastroenterological units in Europe and in America. The assistant nurse cleaned the skin and took the head of the scope from the physician. She also introduced the snare through the scope's channel and grasped the cannula with it. This part of the therapeutic endoscopy is not invasive and is done by many nurses in other procedures.

The sterility of the procedure is restricted because the scope passes through the oral cavity, which is never sterile. Once the cannula reaches the stomach through the abdominal wall, the bacteria of the oral cavity are indeed scattered all over the surgical field. Therefore, cleaning the skin and a sterile field, together with sterile gloves are considered suitable means for sterility in this procedure.