Gastrostomy by various techniques: evaluation of indications, outcome, and complications

Gastrostomy can be performed with a percutaneous fluoroscopic technique, a percutaneous endoscopic technique, or open surgery. Since all three methods are in use at our hospital, we made this retrospective study to compare indications, complications, and outcomes for the different techniques.

During the period January 1990 to December 1994, 147 patients admitted to Lund University Hospital required gastrostomy. The records of these patients were retrospectively studied. Six patient records could not be found, and these patients were therefore excluded. Of the remaining 141 patients, 94 had undergone fluoroscopic percutaneous gastrostomy, 12 percutaneous endoscopic gastrostomy (PEG), and 35 gastrostomy at open surgery. The 30-day overall mortality was 15% in the fluoroscopy group, 17% in the endoscopy group, and 29% in the open surgery group. The 30-day mortality as related to the procedure was 3.2% in the fluoroscopy group, 0% in the PEG group, and 2.9% among the patients with open surgery. The morbidity related to the procedure was 16%, 8%, and 20%, respectively. For the 30-day overall mortality and for the procedure-related mortality there was no statistically significant difference between the groups (P = 0.2019, P = 0.8215). For the percutaneous procedures the indication was nutrition in most patients. For the patients receiving gastrostomy at open surgery drainage was the main indication. Even though the complication rate was higher in this group, most complications were minor, and there was only one procedure-related death. Gastrostomy at open surgery is often performed in severely ill patients. Despite this, it does not seem to cause more complications than the percutaneous techniques in our study.

The study shows that gastrostomies are safe procedures, with few complications and a low procedure-related mortality independent of the technique being used.