Gastrostomy insertion: comparing the options--PEG, RIG or PIG?

Area of Science:

• Gastroenterology
• Interventional Radiology
• Medical Device Technology

Background:

• Percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) are common methods for enteral feeding access.
• Limitations exist for both PEG (e.g., detecting pathology) and RIG (e.g., tube blockage).

Purpose of the Study:

• To compare the efficacy and outcomes of PEG and RIG.
• To evaluate a novel hybrid technique, per-oral image-guided gastrostomy (PIG).

Main Methods:

• Prospective comparison of 50 PEGs and 50 RIGs across three centers.
• Review of endoscopic findings in 200 PEGs.
• Implementation and assessment of a modified fluoroscopy-guided PIG technique in 60 patients.

Main Results:

• Technical success rates were high: 98% (PEG), 100% (RIG), and 100% (PIG).
• PIG demonstrated a significantly lower re-intervention rate (0%) compared to PEG (12%) and RIG (20%).
• PIG was successful in cases where conventional PEG failed, and endoscopic findings were primarily limited to peptic disease.

Conclusions:

• Per-oral image-guided gastrostomy (PIG) combines the advantages of PEG and RIG, offering superior success and reduced re-intervention rates.
• PIG provides better long-term results than RIG and is a viable alternative when PEG is not feasible.
• Endoscopic evaluation during PEG is unlikely to reveal clinically significant pathology beyond peptic disease.