A Meta-analysis and Systematic Review Comparing Percutaneous Endoscopic Gastrostomy Versus Percutaneous Radiologic Gastrostomy

Abstract

Introduction: Different insertion techniques have been used for insertion of percutaneous gastrostomy tube. The aim of this study is to compare the efficacy, complications and mortality of gastrostomy tube insertion by endoscopic and radiological technique by performing a systematic review and meta-analysis. Methods: Pubmed, Embase and Cochrane databases were searched for published controlled studies comparing percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) in human subjects. Quality for each included study was assessed by consort system. Heterogeneity of the studies was analyzed by Cochran's Q statistics. Mantel Haenszel odd ratio were calculated with random effects model. No language or date restrictions were applied. Results: 15 comparative studies on PEG and PRG met our inclusion criteria were used for our metaanalysis involving 2112 patients (1053 PEG, 1059 PRG). Our study found that PRG tube blockage and mortality was higher than PEG with odd ratio (OR): 0.29, (95% CI: 0.10, 0.86) and OR: 0.39, (95% CI: 0.19, 0.80) respectfully. However, there was no significant difference between endoscopic and radiologic techniques in terms of tube dislodgment (OR: 1.01, 95% CI: 0.32, 3.13), leakage (OR: 0.50, 95% CI: 0.20, 1.29), local bleeding (OR: 0.63, 95% CI: 0.14, 2.92), local infection (OR: 0.72, 95% CI: 0.21, 2.43) or peritonitis (OR 0.37, 95% CI: 0.13, 1.04). Conclusion: Our study indicates that PEG is superior to PRG in mortality and tube blockage. However, we cannot rule out the possibility that some of these differences may be related to patient selection bias and tube size used in PRG thus further large randomized trials comparing PEG and PRG will be necessary.