Related Experiment Video
Updated: May 24, 2026
Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection
Published on: September 21, 2015
Effect of the introducer technique compared with the pull technique on the peristomal infection rate in PEG: a
Paulo Moacir Oliveira Campoli1, Adriano Augusto Peclat de Paula, Luana Gomes Alves
1Department of Gastrointestinal Endoscopy, Araujo Jorge Hospital, Goiânia, Goiás, Brazil.
Background:
Peristomal infection is a main complication of PEG. The pull technique appears to be associated with higher infection rates compared with the introducer technique, although published results are controversial.
Objective:
To determine which technique is associated with a higher risk of infection.
Design:
Systematic review and meta-analysis.
Setting:
Studies reporting rates of peristomal infection after PEG performed by either the pull or introducer technique.
Patients:
This study involved 2336 patients from 6 comparative and 10 observational studies.
Intervention:
Public MEDLINE (National Library of Medicine journal articles database), Excerpta Medica Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information databases and proceedings of two meetings, Digestive Disease Week and United European Gastroenterology Week, were searched. Both comparative and observational studies were included and analyzed separately.
Main Outcome Measurements:
Effect measures from each comparative study were reported as the odds ratio (OR). The pooled effect was then calculated. The infection rate in each observational study was also calculated, and a summary effect was then determined.
Results:
In comparative studies, the risk of infection was significantly higher with the pull technique (OR 13.0; 95% confidence interval [CI], 4.6-36.8; P < .0001). Similarly, observational studies also reported higher infection rates with the pull technique (10.7%; 95% CI, 4.9-21.8 with the pull technique vs 0.9%; 95% CI, 0.2-4.5 with the introducer technique).
Limitations:
Few studies were available for inclusion, and there was a high risk of bias among the comparative studies.
Conclusion:
The pull technique appears to be associated with a significantly higher risk of infection compared with the introducer technique.
Insights
The pull technique for percutaneous endoscopic gastrostomy (PEG) insertion is linked to a significantly higher risk of peristomal infection compared to the introducer technique, despite some study limitations.
Area of Science:
- Gastroenterology
- Medical Device Technology
- Infectious Disease
Background:
- Peristomal infection is a common complication following percutaneous endoscopic gastrostomy (PEG) procedures.
- The pull technique for PEG insertion has been anecdotally linked to increased infection rates, but evidence remains controversial.
Purpose of the Study:
- To systematically compare the infection risk associated with the pull versus introducer techniques for PEG placement.
- To determine the definitive technique linked to higher rates of peristomal infection.
Main Methods:
- A systematic review and meta-analysis of published studies.
- Included 6 comparative and 10 observational studies involving 2336 patients.
- Searched major medical databases (MEDLINE, EMBASE, Cochrane) and conference proceedings.
Main Results:
- Comparative studies showed a significantly higher risk of infection with the pull technique (OR 13.0; P < .0001).
- Observational studies corroborated these findings, with higher infection rates for the pull technique (10.7%) versus the introducer technique (0.9%).
Conclusions:
- The pull technique for PEG insertion is associated with a significantly increased risk of peristomal infection.
- Limitations include a small number of available studies and a high risk of bias in comparative studies.
