Comparison of “Pull” and “Introducer” Techniques for Placement of PEG Tubes

Abstract

Introduction: Patients require placement of endoscopic percutaneous gastrostomy (PEG) tube for a number of indications and develop numerous complications as a result of PEG tube placement. There are several techniques for placement of PEG tube including the “pull” method where a guidewire is used to pull the PEG tube through the mouth and the “introducer” technique where gastric anchors are used to allow direct insertion of the tube through the abdominal wall. Comparisons of these two techniques however are limited. Methods: Endoscopic records were reviewed for PEG tube placements from 2011 through 2014 at a single academic medical center to identify appropriate patients for comparison. The technique used for placement was identified and patients were placed into 2 groups. Group 1 was the “pull” PEG procedures and group 2 was the “introducer” PEG procedures. Individual patient characteristics were collected, including the following: age at the time of tube placement, gender, and indication for tube placement. In addition, the electronic medical records were reviewed for each patient to identify any tube related complications that occurred following the initial procedure. Information regarding tube replacement/exchange for each patient was also collected. Results: A total of 75 patients were identified, 50 in group 1 and 25 in group 2. The patients in group 1 were 52% male (26/50) with an average age of 68 years old (+/-12 years). The patients in group 2 were 72% male (18/25) with an average age of 63 years old (+/- 11 years). See Table 1 for the top four indications by PEG tube technique. See Table 2 for the top four complications by PEG tube technique.Table 1: Indications by PEG Tube TechniqueTable 2: Complications by PEG Tube TechniqueConclusion: “Pull” PEGs were placed more often in ALS patients than “introducer” PEGs. “introducer” These patients were more likely to have dysphagia. PEGs were placed more often in Head & Neck cancer patients than “pull” PEGs. Weight loss was more common in this group of patients. Abdominal pain occurred more frequently with the “pull” PEG technique whereas drainage was higher with the “introducer” PEG technique.