PEG Placement: Is the Radiologic, Surgical, or Endoscopic Technique Safest?
Vanessa M. Shami, MD, FASGE, reviewing Kohli DR, et al. Gastrointest Endosc 2021 May.
The optimal technique for gastrostomy tube placement remains undefined. This retrospective study used the Nationwide Readmissions Database and the International Classification of Diseases Procedure Coding System to identify and analyze the outcomes and adverse events of inpatients who underwent creation of a gastrostomy by one of 3 techniques: percutaneous endoscopic gastrostomy (PEG), fluoroscopy-guided gastrostomy by an interventional radiologist (IR-gastrostomy), or open gastrostomy performed by surgery (surgical gastrostomy).
A total of 184,068 patients who underwent inpatient gastrostomy tube placement in 2016 and 2017 were identified: 16,384 underwent PEG, 154,007 received IR-gastrostomy, and 13,677 had surgical gastrostomy. The adjusted odds ratios for adverse events associated with each technique were calculated using multivariable logistic regression analysis.
Compared with PEG, the odds of colon perforation were 1.90 (95% confidence interval [CI], 1.26-2.86; P=.002) with IR gastrostomy and 6.65 (95% CI, 4.38-10.12; P<.001) with surgical gastrostomy; the odds of infection of the gastrostomy were 1.28 (95% CI, 1.07-1.53; P=.006) for IR-gastrostomy and 1.61 (95% CI, 1.29-2.01; P<.001) for surgical gastrostomy; and the odds of bleeding requiring a blood transfusion were 1.84 (95% CI, 1.26-2.68; P=.002) for IR-gastrostomy and 1.09 (95% CI, .64-1.86; P=.746) for surgical gastrostomy. Also compared with PEG, the odds for nonelective 30-day readmission were 1.07 (95% CI, 1.03-1.12; P=.0023) for IR-gastrostomy and 1.13 (95% CI, 1.06-1.2; P=.0002) for surgical gastrostomy, and the odds of inpatient mortality were 1.09 (95% CI, 1.02-1.17; P=.0114) with IR-gastrostomy and 1.55 (95% CI, 1.42-1.69; P<.0001) with surgical gastrostomy.
COMMENTThis study provides data to justify endoscopic placement of gastrostomy tubes. While it is unclear whether this data is generalizable to the outpatient population, as the authors thoughtfully state, prospective, multicenter, randomized trials are needed to determine the optimal method of gastrostomy creation.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Kohli DR, Kennedy KF, Desai M, Sharma P. Safety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment. Gastrointest Endosc 2021;93:1077-1085.e1. (https://doi.org/10.1016/j.gie.2020.09.012)
