Push-PEG or Pull-PEG: Does the Technique Matter? A Prospective Study Comparing Outcomes After Gastrostomy Placement

Area of Science:

• Pediatric Gastroenterology
• Minimally Invasive Procedures
• Surgical Outcomes

Background:

• Percutaneous endoscopic gastrostomy (PEG) is crucial for pediatric nutritional support.
• Push-PEG with T-fastener fixation (PEG-T) offers advantages like one-step insertion and reduced stoma contamination.
• PEG-T presents a steeper learning curve compared to traditional pull-PEG.

Purpose of the Study:

• To compare the clinical outcomes of PEG-T and pull-PEG in pediatric patients.
• To evaluate complication rates, activity restriction, and discomfort associated with each PEG method.
• To assess these outcomes in a setting where both procedures are well-established.

Main Methods:

• A prospective cohort study involving pediatric patients (0-18 years) undergoing PEG-T or pull-PEG between 2017-2020.
• Inclusion of 82 PEG-T patients and 37 pull-PEG patients.
• Systematic recording of complications and parent-reported outcomes during hospital stay, at 14 days, and 3 months postoperatively.

Main Results:

• Overall complication rates were similar between PEG-T (63% late complications) and pull-PEG (62% late complications) at 3 months.
• Significantly fewer PEG-T patients reported activity restriction (24%) compared to pull-PEG (49%) (p=0.01).
• At 3 months, PEG-T was associated with less reported discomfort (21%) than pull-PEG (43%) (p=0.03).

Conclusions:

• While overall complication rates are comparable, PEG-T demonstrates superior patient-reported outcomes in pediatric patients.
• PEG-T is associated with reduced activity restriction and discomfort compared to pull-PEG.
• These findings support PEG-T as a favorable option for pediatric gastrostomy placement, considering patient comfort and quality of life.