Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

Area of Science:

• Gastroenterology
• Endoscopy
• Surgical Techniques

Background:

• Percutaneous endoscopic gastrostomy (PEG) is a common procedure for enteral nutrition.
• Two primary techniques, pull (P) and introducer (I), are used for PEG insertion.
• Comparing the safety and efficacy of these techniques is crucial for patient outcomes.

Purpose of the Study:

• To compare the indications, success rates, and complication profiles of the pull and introducer techniques for PEG insertion.
• To identify risk factors associated with complications in PEG procedures.

Main Methods:

• A retrospective study included 103 inpatients undergoing primary PEG insertion between January 2015 and February 2020.
• Patients were divided into the pull (n=67) and introducer (n=36) groups.
• Data on indications, success rates, complications, and tube replacement were analyzed.

Main Results:

• Both PEG techniques demonstrated high clinical success rates.
• The introducer technique showed a significantly higher rate of tube replacement within six months (11.1% vs 1.5%, P=0.049).
• The pull technique was associated with a lower proportion of esophageal cancer patients (24.4% vs 54.2%, P=0.015).
• No significant difference in overall, major, or minor complications was observed between groups.
• Esophageal stenosis was a risk factor for complications with the pull method (OR=12, P=0.03).
• Risk factors for major complications included a longer admission-to-gastrostomy interval (OR=1.078, P=0.014), and for minor complications, lack of antibiotic use (OR=4.735, P=0.022).

Conclusions:

• Both percutaneous endoscopic gastrostomy techniques are effective, but the introducer method is preferable for patients with esophageal strictures.
• The pull technique is associated with a lower rate of tube replacement.
• Prophylactic antibiotic use and early PEG insertion may mitigate complications.