Upper GI-endoscopy is one of gastroenterology's most frequently performed diagnostic and interventional methods. Even though gastroscopy is believed to be a routine investigation - which is the greatest mistake of all - several pitfalls in performance can cause serious problems or misdiagnoses. Struggles in accurately describing and classifying abnormal findings can occur and concern the correct basic technique of endoscope introduction, and the correct way of investigating the mucosal surface in total, with several available imaging modalities such as virtual chromoendoscopy or magnification. Which classification systems should be used? The decision to perform additional workup needs to be made immediately during the ongoing endoscopy. Is it necessary to take biopsies, or should it even be avoided due to potential interference with a later endoscopic resection? This article answers the questions, highlights the most common mistakes with clinical relevance and expands on how to avoid them.

Adequate nutrition is essential for the homeostasis of fluids and nutrients, growth and thriving, especially in children. While the underlying principle of percutaneous endoscopic gastrostomy (PEG) placement is the same for both adults and children—providing a means of enteral feeding through the stomach—the indications, considerations and techniques differ owing to anatomical differences, age-dependent physiological concerns, and the age- and disease-specific needs of the child.

If feeding via nasogastric tube (NGT) or naso-jejunal tube (NJT) is necessary for a prolonged time, placement of a PEG or percutaneous endoscopic gastro-jejunal (PEG-J) tube should be considered. A PEG tube also allows the delivery of medications and venting of the stomach when needed. Nutrition via PEG facilitates the transition to out-of-hospital care and improves the quality of life (QoL) for children and families while improving the outcome of children with chronic diseases.

There are recent clinical guidelines providing guidance for PEG tube placement in children, but little advice on, e.g., choosing the right device for the right patient, details on postoperative management, removal of the PEG tube and other specific cases. The following article provides a combination of evidence-based data and the authors’ clinical experience.