Is percutaneous better than open gastrostomy? A clinical study in one surgical department

Percutaneous endoscopic gastrostomy (PEG) has become an acceptable alternative to open gastrostomy since its inception in 1981. The PEG procedure has been assumed by most to have lesser associated morbidity and mortality and to be more cost effective. Only a few studies have compared the two procedures, and even fewer cost comparisons have been performed. A review of the literature and a retrospective study was performed over a three-year period examining eighty-eight consecutive patients who underwent either PEG (48) or gastrostomy (4) for feeding purposes only by the same group of surgeons. Patients undergoing PEG or gastrostomy tube placement in association with other procedures were excluded from the study. The results of our experiences with PEG versus open gastrostomy revealed no difference in age or gender. Intraoperative morbidity was higher (50%) for PEG than for gastrostomy (2.5%). Six-month follow-up mortality was 30 per cent and 32 per cent for PEG and gastrostomy. The cost for PEG ($1360) was approximately half the cost for gastrostomy ($2448). This study demonstrates that PEG has a significantly higher intraoperative morbidity rate relative to open gastrostomy, whereas both carry a substantial percentage of late complications. Problems often encountered with PEG included suture breakage, inadvertent colon puncture, local peritonitis, and inability to keep the stomach inflated. Late complications seen with open gastrostomy were wound infection, wound dehiscence, and respiratory complications. No deaths were a direct result of either procedure, and long-term mortality rates were comparable. PEG was clearly more cost effective.(ABSTRACT TRUNCATED AT 250 WORDS)