Incision vs. Non-Incision Technique of PEG Tube Placement, Success Rate and Early Complications

Abstract

Purpose: Percutaneous endoscopic gastrostomy (PEG) tube placement with and without skin incision were compared with regard to success of technique, ease of placement, and early PEG site complications in a randomized, controlled, double blinded prospective study. Methods: 50 consecutive patients were randomized to PEG tube placement by pull technique with either 4 mm skin incision (n = 25) or no skin incision (n = 25). Patients were blinded to type of technique used. 92% of patients in each group received antibiotics. Peak pull-forces required to pull PEG through the abdominal wall, bleeding scores and time of procedure were recorded by an operator. All patients received standardized wound care. At days 2 and 7 post-PEG placement an investigator blinded to the type of technique assessed patients for PEG site skin infection, bleeding, and pain. Results: PEG placement was 100% successful in both groups of patients with no differences in procedure time. The mean procedure time for the incision group was 14.6 min; for the non-incision group it was 15.6 min (P > 0.05). Mean bleeding score during procedure was higher in the incision group 0.4 vs. non-incision group 0.12 (P < 0.05), while mean peak pull-forces were higher in the non-incision group 19.04 lb vs. incision group 11.69 lb (P < 0.05). One patient in the incision group required suturing and pressure to control continuing oozing of blood after the procedure. Mean infection scores were 0.16 for the incision group vs. 0 for the non-incision group (P > 0.05) on day 2, and 0.43 for the incision group vs. 1.37 for the non-incision group (P = 0.055) on day 7. Purulent MRSA PEG site abdominal wall infection in one patient from the non-incision group necessitated early PEG tube withdrawal and additional antibimicrobial therapy. Mean bleeding scores were 0.25 for the incision group vs. 0 for the non-incision group (P < 0.05) on day 2, and 0.13 for the incision group vs. 0.08 for the non-incision group (P > 0.05) on day 7. There was no statistically significant difference in pain scores on day 2 or 7. The mean pain score was <1 in both groups. Conclusions: PEG tube placement was feasible in all patients with both incision and non-incision techniques. When compared with the incision technique, the non-incision technique required significantly more forces to pull the PEG tube through the abdominal wall, was associated with lower periprocedural bleeding, and had higher mean infection scores on post-procedure day 7.