Is percutaneous radiologic gastrostomy safer than percutaneous endoscopic gastrostomy?

Abstract

Objectives: The objectives of the study were to compare the indications, adverse events, removal rates, and mortality of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) techniques at our tertiary care institution from 2014 to 2019. Material and Methods: We undertook a 5-year retrospective review of patients who underwent either PEG or PRG at our institution from 2014 to 2019. Common adverse events include tube clogs, leaks, minor bleeds, and wound infections, while more rare major complications include peritonitis, intra-abdominal infection, and major hemorrhage. The procedures were all performed with either conscious sedation or general anesthesia. A total of 789 patients were reviewed, of whom 519 (65.8%) had a PRG and 270 (34.2%) had a PEG. PRGs were more likely to be placed for head-and-neck cancer (P < 0.0001) and amyotrophic lateral sclerosis (P < 0.0001), while PEGs were more likely to be placed for gastric outlet obstruction (GOO) (P <.0001) and malnutrition (P < 0.0001). Results: The rate of major adverse events was similar between the two groups (P = 0.938). GI placed gastrostomy tubes were more likely to have a minor adverse event (P < 0.0001), however, this was secondary to a significant increase in tube clog in the PEG/J group as compared to PEG (P < 0.0001). Conclusion: The decision to place a PEG or PRG should be individualized to the patient’s specific condition and indication. Both procedures have favorable safety profiles, and it is likely that institutional expertise and procedural access will be the primary determinants of the procedural technique chosen for minimally invasive gastrostomy.