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Prospective randomized trial comparing the direct method using a 24 Fr bumper-button-type device with the pull method

A Horiuchi¹, Y Nakayama, N Tanaka

¹Department of Gastroenterology, Showa Inan General Hospital, Komagane, Japan. horiuchi.akira@sihp.jp

|September 6, 2008

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A new direct method for percutaneous endoscopic gastrostomy (PEG) significantly reduces peristomal infections and the need for catheter changes compared to the standard pull method, improving long-term outcomes for patients requiring enteral feeding.

Area of Science:

Gastroenterology
Minimally Invasive Surgery
Medical Device Technology

Background:

Percutaneous endoscopic gastrostomy (PEG) is essential for long-term enteral feeding.
Traditional PEG placement involves a standard pull method.
Evaluating alternative PEG techniques is crucial for improving patient outcomes.

Purpose of the Study:

To compare a direct introducer method with a bumper-button device against the standard pull method for PEG placement.
To assess the efficacy and safety of the direct PEG method.

Main Methods:

A randomized study comparing direct (24 Fr bumper-button) and pull (20 Fr) PEG methods in 140 patients with dysphagia.
Primary outcome: rate of peristomal infections within 30 days.
Secondary outcomes: success rates, procedure time, complications, and catheter changes within 180 days.

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Main Results:

The direct method showed a significantly lower rate of peristomal infections (0 vs. 6, P=0.028).
Procedure success (100%) and time were similar between groups.
Catheter replacement was significantly less frequent with the direct method (75% vs. 45.2% no change in 180 days, P=0.0019).

Conclusions:

The direct PEG method with a bumper-button device reduces early peristomal infections.
This technique also decreases the need for long-term catheter replacement compared to the standard pull method.
The direct method offers an improved approach for long-term enteral feeding via PEG.