# Psychomotor Retardation — GCMD Library living collection

Everything in the library about psychomotor retardation — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 100 cited statements

## Episodes
### In-Depth Reviews
- [SAGES Stories Episode 11 – Jeff Ponsky, MD](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684) — video · 1:01:24 · [machine version](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684.md)
- [SAGES Stories: Dr. Jeffrey Ponsky on surgical endoscopy and the PEG tube legacy](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687) — podcast · 1:01:24 · [machine version](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687.md)
- [The invention of the PEG tube with Dr. Jeffrey Ponsky](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689) — podcast · 33:47 · [machine version](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=0) Introduction and Early Life (Ep 1)
- [6:35](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=395) Medical School and Surgical Training (Ep 1)
- [16:44](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1004) Introduction to Endoscopy (Ep 1)
- [28:20](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1700) Development of the PEG Tube (Ep 1)
- [31:50](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1910) Career Transitions and ERCP (Ep 1)
- [47:47](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2867) SAGES History and Evolution (Ep 1)
- [51:06](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3066) Life Philosophy and Closing (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=0) Introduction and early life struggles (Ep 2)
- [6:35](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=395) Medical school and surgical training influences (Ep 2)
- [18:02](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1082) Entry into surgical endoscopy and PEG tube invention (Ep 2)
- [29:21](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1761) Mount Sinai tenure and early laparoscopy (Ep 2)
- [36:56](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2216) Career transitions and family integration (Ep 2)
- [47:47](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2867) SAGES evolution and endoscopy in surgery (Ep 2)
- [53:12](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=3192) Life philosophy, hobbies, and SAGES memories (Ep 2)
- [0:59](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=59) Introduction and Background (Ep 3)
- [2:27](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=147) Genesis of the PEG Tube Concept (Ep 3)
- [6:47](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=407) First Clinical Cases and Early Development (Ep 3)
- [8:26](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=506) Commercialization and Technical Evolution (Ep 3)
- [10:59](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=659) Endoscopy as a Surgical Tool (Ep 3)
- [14:13](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=853) Endoscopic Technology in the Late 1970s (Ep 3)
- [19:59](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1199) Scope Cleaning and Early Nursing Collaboration (Ep 3)
- [21:22](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1282) FDA Approval and Expanded Indications (Ep 3)
- [24:20](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1460) Initial Reception and Adoption Patterns (Ep 3)
- [26:33](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1593) Future Innovation and Advice to Trainees (Ep 3)
- [31:57](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1917) Closing Remarks (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Ponsky had a 2.027 GPA graduating from Cleveland Heights High School and his college counselor recommended trade school instead of college. — Jeffrey Ponsky (clinical) [Ep 1 · 6:49](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=409)
- Ponsky's transformation in college came from memorizing everything and studying constantly, discovering he had an exceptional memory that allowed him to 'eat the book and spit it out.' — Jeffrey Ponsky (opinion) [Ep 1 · 9:17](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=557)
- Gastroenterologists at University Hospitals refused to train surgeons in endoscopy, telling Ponsky 'we're not training any surgeons.' — Jeffrey Ponsky (clinical) [Ep 1 · 25:21](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1521)
- Ponsky trained in endoscopy with Jim King in Canton, Ohio, performing approximately 500 cases over 5-6 months during an extended elective. — Jeffrey Ponsky (clinical) [Ep 1 · 25:47](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1547)
- Early endoscopes were cleaned with green soap and stored in the back of cars, without high-level disinfection protocols. Operators did not wear gloves during procedures. — Jeffrey Ponsky (clinical) [Ep 1 · 26:57](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1617)
- The PEG (percutaneous endoscopic gastrostomy) was developed in May 1979 by Ponsky and pediatric gastroenterologist Mike Gower, with the first five cases performed on babies with birth asphyxia and psychomotor retardation. — Jeffrey Ponsky (clinical) [Ep 1 · 31:23](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1883)
- The PEG procedure was developed without IRB approval, only discussing the approach with patients' families. — Jeffrey Ponsky (clinical) [Ep 1 · 31:31](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1891)
- Ponsky became chief of surgery at Mount Sinai Hospital at age 32 in 1979. — Jeffrey Ponsky (clinical) [Ep 1 · 31:50](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1910)
- Ponsky performed 1,600 colonoscopies in a single year during his practice. — Jeffrey Ponsky (clinical) [Ep 1 · 41:34](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2494)
- The distal splenorenal shunt, once considered a great operation based on physiology to reduce variceal pressure without decreasing portal flow, became obsolete when endoscopic variceal banding was introduced. — Jeffrey Ponsky (clinical) [Ep 1 · 40:27](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2427)
- Ponsky performed 180 vertical banded gastroplasties in one year in the mid-1980s, an operation that later required reversal in many patients. — Jeffrey Ponsky (clinical) [Ep 1 · 41:05](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2465)
- ERCP was developed primarily in Japan by Itaru Oi and colleagues, with contributions from German physicians and Peter Cotton's group in London. — Jeffrey Ponsky (clinical) [Ep 1 · 43:09](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2589)
- Ponsky learned ERCP primarily through watching videos and self-teaching, then traded training with George Brodmerkel in Pittsburgh—teaching him laparoscopy under local anesthesia in exchange for learning sphincterotomy. — Jeffrey Ponsky (clinical) [Ep 1 · 43:40](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2620)
- Walter Pore taught pinch grafting technique at Metro Hospital, where students would inject local anesthesia, harvest small 'postage stamp' skin grafts from the thigh, and apply them to debrided bedsores. Pore emphasized giving patients zinc supplementation. — Jeffrey Ponsky (clinical) [Ep 1 · 21:12](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1272)
- Early SAGES meetings focused on surgical problem-solving with endoscopy, addressing topics like managing bowel obstruction, evaluating suture lines, and treating intestinal volvulus endoscopically—distinct from ASGE's focus. — Jeffrey Ponsky (clinical) [Ep 1 · 48:24](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=2904)
- When SAGES started, it had approximately 300 members. When Ponsky became president in 1990, the society was giving courses on surgical endoscopy and its relationship to surgical problem-solving. — Jeffrey Ponsky (clinical) [Ep 1 · 28:30](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1710)
- Jacques Perissat showed the video of laparoscopic cholecystectomy in the exhibit hall at the SAGES meeting in Louisville, Kentucky, marking a pivotal moment when Ponsky was SAGES president. — Jeffrey Ponsky (clinical) [Ep 1 · 28:48](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1728)
- When laparoscopic cholecystectomy was introduced, instruments could not be purchased and surgeons had to use gynecologic instruments initially. — Jeffrey Ponsky (clinical) [Ep 1 · 29:04](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1744)
- Ponsky took one of the first laparoscopic cholecystectomy courses taught by Nat Soper, George Bercy, John Hunter, and John Sackier in Salt Lake City. — Jeffrey Ponsky (clinical) [Ep 1 · 29:10](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1750)
- Ponsky's first two laparoscopic cholecystectomies at Mount Sinai were proctored by David Dupper, who had performed only 8 cases himself at that time. The first patient was a member of the hospital's board of trustees. — Jeffrey Ponsky (clinical) [Ep 1 · 29:27](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1767)
- Ponsky advocated to the Residency Review Committee (when Joe Fisher was head) for a minimum endoscopy requirement in general surgery training. The initial requirement of 50 cases was controversial but established endoscopy as a required component of general surgery. — Jeffrey Ponsky (clinical) [Ep 1 · 50:09](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=3009)
- Ponsky became director of surgical endoscopy at University Hospitals at age 29 as a new attending. — Jeffrey Ponsky (clinical) [Ep 1 · 30:31](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1831)
- Mount Sinai Hospital had an animal laboratory that was larger than Cleveland Clinic's laboratory, providing Ponsky freedom to conduct courses and train fellows. — Jeffrey Ponsky (clinical) [Ep 1 · 32:54](https://library.globalcastmd.com/watch/sages-stories-episode-11-jeff-ponsky-md-13684?t=1974)
- In the late 1970s, surgical residents were on call every other night (36 hours on, 12 hours off) for five years of training. — Jeffrey Ponsky (clinical) [Ep 3 · 15:31](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=931)
- In 1974-1975, there were no pediatric gastroenterologists, and Ponsky performed endoscopy on children, young adults, and neonates with GI problems using his personally owned scope. — Jeffrey Ponsky (clinical) [Ep 3 · 3:27](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=207)
- During neonatal endoscopy, the room would light up because babies were so thin; when pediatric surgeon Michael Gower pushed on the transilluminated light with his finger, an indentation was visible endoscopically. — Jeffrey Ponsky (clinical) [Ep 3 · 4:33](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=273)
- The first PEG tubes were constructed from OR gastrostomy tubes (small Pezzer catheters) with sutures threaded through the end and passed through an IV catheter (medicut) to create a dilator tip. — Jeffrey Ponsky (clinical) [Ep 3 · 4:59](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=299)
- The first five PEG procedures in May 1979 were performed in neonates with severe psychomotor retardation who were brain dead, fed by nasogastric tubes, had no chance of recovery, and were being sent for open gastrostomy before long-term nursing facility placement. — Jeffrey Ponsky (clinical) [Ep 3 · 5:42](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=342)
- Informed consent for the first PEG cases consisted of telling mothers that if the new technique failed, immediate laparotomy and open gastrostomy would be performed. — Jeffrey Ponsky (clinical) [Ep 3 · 6:25](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=385)
- The first PEG procedures succeeded easily within a few minutes. — Jeffrey Ponsky (clinical) [Ep 3 · 6:42](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=402)
- After the initial five neonatal cases, Ponsky moved to Mount Sinai Medical Center and began performing PEG in adult stroke patients with similar neurologic prognosis who needed feeding access. — Jeffrey Ponsky (clinical) [Ep 3 · 6:47](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=407)
- Laboratory studies on PEG tract formation, tube dwell time before safe replacement, and leakage risk were conducted after clinical implementation—the reverse of typical research-then-clinical sequence. — Jeffrey Ponsky (clinical) [Ep 3 · 7:13](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=433)
- John Mellinger, who later worked at the American Board of Surgery, conducted original research on PEG tract formation. — Jeffrey Ponsky (clinical) [Ep 3 · 7:28](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=448)
- Multiple medical device companies refused to manufacture the PEG tube initially, believing nobody would use it. — Jeffrey Ponsky (clinical) [Ep 3 · 8:39](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=519)
- A small company in Mentor, Ohio eventually manufactured the PEG tube exactly as designed by Ponsky and Gower. — Jeffrey Ponsky (clinical) [Ep 3 · 8:54](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=534)
- Ponsky and Gower never patented the PEG tube; they were more interested in publication than patents and wanted to disseminate the technique. — Jeffrey Ponsky (opinion) [Ep 3 · 9:06](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=546)
- PEG tube complications included rare colonic perforation when the tube traversed the colon en route to the stomach, which still occurs rarely today. — Jeffrey Ponsky (clinical) [Ep 3 · 9:39](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=579)
- Exit-site infection was a major early PEG complication. — Jeffrey Ponsky (clinical) [Ep 3 · 9:51](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=591)
- PEG tubes evolved from multi-piece rubber construction to one-piece silicone, but have had very few modifications in the last few years and have become a commodity product purchased by hospitals at the lowest price. — Jeffrey Ponsky (clinical) [Ep 3 · 10:24](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=624)
- The PEG technique has remained very much the same as the original with only a few modifications. — Jeffrey Ponsky (clinical) [Ep 3 · 10:50](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=650)
- Ponsky and the manufacturing company conducted dozens of animal experiments to determine tube removal pressure, tip retention, and optimal tube size for FDA approval. — Jeffrey Ponsky (clinical) [Ep 3 · 11:19](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=679)
- In 1975, Ponsky developed and published endoscopic tattooing using India ink injected alongside polypectomy sites to mark the location for potential surgical resection if cancer was found; the technique remains in use today. — Jeffrey Ponsky (clinical) [Ep 3 · 12:55](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=775)
- The PEG tube was the first and only time any instrument or needle was thrust through the abdominal wall into the GI tract and left in place. — Jeffrey Ponsky (clinical) [Ep 3 · 12:13](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=733)
- In the mid-1970s, the predominant American endoscope was the ACMI (American Cystoscope Makers Incorporated) with a joystick control, approximately 1 cm diameter, with image quality like looking through ground glass. — Jeffrey Ponsky (clinical) [Ep 3 · 17:35](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1055)
- Japanese companies (Mashida and Olympus in the US) produced fiber-optic endoscopes with crystal-clear optics that were markedly superior to American models. — Jeffrey Ponsky (clinical) [Ep 3 · 18:03](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1083)
- 1970s fiber-optic endoscopes transmitted light via fiber bundles to the lumen and returned images to the eyepiece; photography required clipping a camera to the eyepiece for film-strip images. — Jeffrey Ponsky (clinical) [Ep 3 · 18:26](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1106)
- Teaching attachments for 1970s endoscopes consisted of a wire-connected second eyepiece that provided a dim image for trainees in darkened rooms. — Jeffrey Ponsky (clinical) [Ep 3 · 18:51](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1131)
- Around 1980, video chip technology placed a camera at the endoscope tip instead of using fiber-optic image transmission, displaying images on large monitors—the technology used in current endoscopes. — Jeffrey Ponsky (clinical) [Ep 3 · 19:06](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1146)
- In the late 1970s, neonates could tolerate endoscopes approximately 9 millimeters wide, which was the limit for safe use. — Jeffrey Ponsky (clinical) [Ep 3 · 19:36](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1176)
- The original PEG procedure was performed with an adult endoscope. — Jeffrey Ponsky (clinical) [Ep 3 · 19:57](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1197)
- In the 1970s, endoscopes were cleaned between procedures using only green soap; high-level disinfection and sterilization protocols did not yet exist. — Jeffrey Ponsky (clinical) [Ep 3 · 20:56](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1256)
- The PEG tube received FDA 510(k) approval as a modification of existing gastrostomy tubes used for similar purposes, which is easier than approval for entirely novel devices. — Jeffrey Ponsky (clinical) [Ep 3 · 21:45](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1305)
- PEG indications expanded beyond feeding to include gastric decompression in gastroparesis or obstruction (including carcinomatosis), delivery of unpalatable feedings, and treatment of gastric volvulus. — Jeffrey Ponsky (clinical) [Ep 3 · 22:17](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1337)
- The PEG technique was adapted for colonic applications including sigmoid volvulus fixation and Ogilvie syndrome decompression, with multiple PEGs used for sigmoid volvulus. — Jeffrey Ponsky (clinical) [Ep 3 · 23:00](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1380)
- Many endoscopic procedures developed by surgeons, including PEG, were extensions of surgical operations already performed via laparotomy. — Jeffrey Ponsky (opinion) [Ep 3 · 23:56](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1436)
- Gastroenterologists rapidly adopted PEG as a therapeutic procedure they could easily accomplish, driving widespread dissemination. — Jeffrey Ponsky (clinical) [Ep 3 · 25:32](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1532)
- Surgeons were slower to adopt PEG initially because they were not performing as much therapeutic endoscopy at that time, but they did not offer significant resistance. — Jeffrey Ponsky (clinical) [Ep 3 · 25:56](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1556)
- A properly performed PEG procedure takes under 5 minutes when done carefully by an experienced operator. — Jeffrey Ponsky (clinical) [Ep 3 · 26:40](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1600)
- Current PEG procedures still require patient sedation or anesthesia and constitute an intervention. — Jeffrey Ponsky (clinical) [Ep 3 · 26:47](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1607)
- Radiologists perform gastrostomy tube placement using ultrasound guidance, though Ponsky does not prefer the tubes they use. — Jeffrey Ponsky (opinion) [Ep 3 · 27:43](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1663)
- Ponsky graduated Cleveland Heights High School with a 2.027 GPA and was advised by his counselor to consider trade school instead of college. — Jeffrey Ponsky (clinical) [Ep 2 · 6:49](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=409)
- Ponsky's transformation in college came from memorizing everything and studying constantly, discovering he had an 'unbelievable' memory that allowed him to 'eat the book and spit it out.' — Jeffrey Ponsky (opinion) [Ep 2 · 9:44](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=584)
- Working as an orderly at Mount Sinai Hospital, Ponsky gave bed baths, changed bedpans, and cared for a high school classmate who became paraplegic after an auto accident, which deepened his commitment to medicine. — Jeffrey Ponsky (clinical) [Ep 2 · 10:59](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=659)
- Ponsky was promoted to scrub tech and surgeons allowed him to close fascia, despite the head nurse objecting that he wasn't permitted to do so. — Jeffrey Ponsky (clinical) [Ep 2 · 12:15](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=735)
- Ponsky never took calculus, using logarithms to work around it in physics, and the Case Western dean of admissions accepted him despite this after he stated he had already been admitted to two other medical schools. — Jeffrey Ponsky (clinical) [Ep 2 · 12:43](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=763)
- Ponsky chose Case Western Reserve (then Western Reserve) over Northwestern and Cincinnati primarily because his family lacked money and he needed to live at home rather than pay rent elsewhere. — Jeffrey Ponsky (clinical) [Ep 2 · 14:14](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=854)
- Bill Holden, chairman of surgery at Case, was an 'elegant' teacher who used the Socratic method and prioritized teaching over technical skill. — Jeffrey Ponsky (opinion) [Ep 2 · 19:43](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1183)
- Walter Parry taught using theatrical methods, including having students smell a room to perceive 'the smell of death' (though there was no actual smell) and performing bedside pinch grafts on bedsores at Metro Hospital. — Jeffrey Ponsky (clinical) [Ep 2 · 20:20](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1220)
- Parry made Ponsky rewrite his first paper—a letter to the New England Journal about paradoxical air embolism—six times and read German poetry to him to encourage more poetic medical writing. — Jeffrey Ponsky (clinical) [Ep 2 · 22:33](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1353)
- When Ponsky requested an endoscopy elective as a resident, the head of GI at University Hospitals refused, stating 'we're not training any surgeons.' — Jeffrey Ponsky (clinical) [Ep 2 · 25:08](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1508)
- Charles Hube arranged for Ponsky to train with Jim King in Canton, Ohio, where Ponsky performed approximately 500 colonoscopy cases over 5-6 months using a mid-length scope not designed to reach the cecum. — Jeffrey Ponsky (clinical) [Ep 2 · 25:47](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1547)
- After returning from Canton, the head of gastroenterology told Ponsky 'you're not gonna touch this scope,' so he used the VA's Olympus colonoscope instead. — Jeffrey Ponsky (clinical) [Ep 2 · 26:19](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1579)
- Ponsky's mother-in-law purchased his first colonoscope after hearing at a family dinner that he couldn't get access to equipment; in that era, scopes were washed with green soap and stored in car trunks. — Jeffrey Ponsky (clinical) [Ep 2 · 26:51](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1611)
- As a senior resident, Ponsky performed emergency endoscopy cases day and night with Bob Zollinger Junior signing the paperwork, eventually doing all cases while GI physicians stopped performing them. — Jeffrey Ponsky (clinical) [Ep 2 · 27:13](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1633)
- The PEG tube was invented in May 1979 when Ponsky and pediatric surgeon Michael Gower used transillumination (seeing light shine through the abdominal wall during endoscopy in neonates) to develop a minimally invasive gastrostomy technique, performing it on five babies with birth asphyxia and psychomotor retardation. — Jeffrey Ponsky (clinical) [Ep 2 · 31:11](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1871)
- The PEG tube procedure was performed without IRB approval; Ponsky and Gower only spoke with the patients' families before proceeding. — Jeffrey Ponsky (clinical) [Ep 2 · 31:31](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1891)
- Ponsky became chief of surgery at Mount Sinai Hospital at age 32, shortly after inventing the PEG tube. — Jeffrey Ponsky (clinical) [Ep 2 · 31:50](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1910)
- Mount Sinai was Ponsky's 'favorite place I ever worked in my life'—a small hospital where every staff member knew each other, with an animal research laboratory larger than Cleveland Clinic's. — Jeffrey Ponsky (opinion) [Ep 2 · 32:44](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1964)
- Ponsky left Mount Sinai in 1997 after 18 years when the hospital was sold to a for-profit company whose leadership 'could care less about quality.' — Jeffrey Ponsky (opinion) [Ep 2 · 33:36](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2016)
- At the 1990 SAGES meeting in Louisville, Kentucky, Jacques Perissat showed video of laparoscopic cholecystectomy in the exhibit hall; Ponsky was SAGES president at the time and 'right in on the ground floor.' — Jeffrey Ponsky (clinical) [Ep 2 · 28:48](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1728)
- Early laparoscopic instruments were unavailable for purchase, so surgeons used gynecology instruments. Ponsky took one of the first training courses taught by Nat Soper, George Berci, John Hunter, and John Sackier in Salt Lake City. — Jeffrey Ponsky (clinical) [Ep 2 · 29:06](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1746)
- Ponsky's first two laparoscopic cholecystectomy cases at Mount Sinai were performed on a board of trustees member, proctored by David Dupper who had completed only eight cases himself. — Jeffrey Ponsky (clinical) [Ep 2 · 29:27](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1767)
- Ponsky initially felt like a 'traitor' to ASGE when SAGES started because he was already on the ASGE governing board. — Jeffrey Ponsky (opinion) [Ep 2 · 47:50](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2870)
- At early SAGES meetings, papers focused on surgical problem-solving with endoscopy (bowel obstruction evaluation, suture line assessment, volvulus management)—topics distinct from ASGE content—which convinced Ponsky of the society's unique value. — Jeffrey Ponsky (opinion) [Ep 2 · 48:24](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2904)
- When SAGES started, it had approximately 300 members; when Ponsky became president in 1990, the society was giving courses on surgical endoscopy and its relationship to surgical problem-solving. — Jeffrey Ponsky (clinical) [Ep 2 · 28:30](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=1710)
- Ponsky advocated to the Residency Review Committee (when Joe Fisher was head) for a minimum endoscopy case requirement in general surgery training; the 50-case requirement was initially controversial but established endoscopy as a core surgical competency. — Jeffrey Ponsky (clinical) [Ep 2 · 50:09](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=3009)
- Ponsky performed 1600 colonoscopies in his final year of practice, predicting that in 20 years colonoscopy for screening may be obsolete. — Jeffrey Ponsky (opinion) [Ep 2 · 41:34](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2494)
- ERCP is Ponsky's favorite procedure, which he describes as 'like golf for some people'—he would come in day or night to perform it and considers it a sophisticated procedure requiring 'body English.' — Jeffrey Ponsky (opinion) [Ep 2 · 42:07](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2527)
- Ponsky learned ERCP largely self-taught by watching videos, then arranged a teaching exchange with George Brodmerkel in Pittsburgh: Ponsky taught Brodmerkel laparoscopy under local anesthesia for liver biopsy, and Brodmerkel taught Ponsky sphincterotomy. — Jeffrey Ponsky (clinical) [Ep 2 · 43:40](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2620)
- Ponsky obtained an executive MBA at the urging of hospital administrators who said he made decisions 'out of your gut' without understanding return on investment or financing; he describes the MBA as learning 'the language of business' and when to 'say bullshit at the right time' in business meetings. — Jeffrey Ponsky (opinion) [Ep 2 · 44:54](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2694)
- Ponsky performed 180 vertical banded gastroplasty procedures in one year during the mid-1980s, believing it would be a great bariatric operation, but later surgeons had to reverse many of them. — Jeffrey Ponsky (clinical) [Ep 2 · 41:05](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2465)
- Ponsky performed distal splenorenal shunts early in his career at University Hospitals with Jerry Walkoff's assistance, believing the operation was 'the greatest thing since sliced bread' based on Dean Warren's physiologic approach, but the procedure became obsolete when endoscopic variceal banding was introduced. — Jeffrey Ponsky (clinical) [Ep 2 · 40:27](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2427)
- Ponsky had all but one of his children before finishing residency; his last son was born during his final year of residency, and his daughter was born three years later after he joined Mount Sinai. — Jeffrey Ponsky (clinical) [Ep 2 · 34:21](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2061)
- Ponsky's wife had no partners helping her while he was on call every other night, but he credits his family—wife, children, and in-laws—as essential to his success, stating 'our success was a joint success, not just my success.' — Jeffrey Ponsky (opinion) [Ep 2 · 34:43](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2083)
- Ponsky's greatest academic achievement was becoming chairman of the Department of Surgery at Case Western Reserve, though his parents were most proud of his role as chief of surgery at Mount Sinai because it was meaningful within the Jewish community they knew. — Jeffrey Ponsky (opinion) [Ep 2 · 36:32](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2192)
- Ponsky has counseled fellows away from positions at his own institutions when he believed better opportunities existed elsewhere, considering factors like family proximity, academic opportunity, and institutional need rather than institutional prestige. — Jeffrey Ponsky (opinion) [Ep 2 · 38:47](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=2327)
- Ponsky's philosophy is to 'always volunteer, never say no, get involved in everything'—he believes people will find the time, decisions don't need to be belabored, and residents can help with much of the work. — Jeffrey Ponsky (opinion) [Ep 2 · 51:55](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=3115)
- Ponsky lives on 8 acres with horses; his son Zach built a house on the adjacent 5-acre lot, his daughter bought a house two properties away with another 5 acres, son Todd lives within half a mile, and son Lee lives 'almost 2 miles' away—creating a family compound in Cleveland. — Jeffrey Ponsky (clinical) [Ep 2 · 56:12](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=3372)
- Ponsky has a house in Florida and would travel there for long weekends during his working years, leaving Friday morning at 6 AM and returning Monday, using vacation days for Friday and Monday. — Jeffrey Ponsky (clinical) [Ep 2 · 57:22](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=3442)
- Ponsky's wife purchased him a Harley-Davidson trike (three-wheeled motorcycle) when he turned 70; she would not permit a two-wheel motorcycle. They have ridden to Sturgis, South Dakota. — Jeffrey Ponsky (clinical) [Ep 2 · 55:24](https://library.globalcastmd.com/watch/sages-stories-dr-jeffrey-ponsky-on-surgical-endoscopy-and-the-peg-tube-legacy-13687?t=3324)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- A Mayo Clinic study by Larson demonstrated that a single perioperative antibiotic dose almost eliminated PEG exit-site infections, establishing perioperative antibiotics as standard practice. — Jeffrey Ponsky summarizing a resource [Ep 3 · 9:58](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=598)
- At the 1980 Salt Lake City GI meeting with approximately 1500 attendees, a prominent Mass General surgeon stated he could perform open gastrostomy in 30 minutes and it was not a big deal. — Jeffrey Ponsky summarizing a resource [Ep 3 · 24:45](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1485)
- At the same 1980 meeting, a world-renowned ERCP expert stated his only comment was 'I wish I had thought of it.' — Jeffrey Ponsky summarizing a resource [Ep 3 · 25:24](https://library.globalcastmd.com/watch/the-invention-of-the-peg-tube-with-dr-jeffrey-ponsky-13689?t=1524)

## Changelog
- Oct 5: 3 items added automatically

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