Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre

Area of Science:

• Medical procedures
• Gastroenterology
• Surgical complications

Background:

• Percutaneous gastrostomy is a common procedure for nutritional support.
• Both PUSH and PULL techniques are utilized for gastrostomy placement, via endoscopic (PEG) or radiological (PRG) methods.
• Complication rates and types may differ between PUSH and PULL techniques.

Purpose of the Study:

• To compare the complication rates of PUSH versus PULL techniques for percutaneous gastrostomy.
• To evaluate complications associated with both endoscopic (PEG) and radiological (PRG) gastrostomy procedures.

Main Methods:

• A prospective observational study included 423 adult patients undergoing PUSH or PULL gastrostomy (PEG or PRG) between 2009-2020.
• Statistical analysis, including chi-squared or Fisher's exact tests, compared complication proportions.
• Univariate analysis identified risk factors for PRG-associated complications.

Main Results:

• The PULL technique (n=181) showed a higher incidence of total complications (37.6%) compared to the PUSH technique (n=242) (23.8%; p=0.005).
• Specific complications like exudate and irritation were more frequent with the PULL technique.
• Overall severe complications were low, including 5 cases of peritonitis, 3 gastrocolic fistulas, and 1 death.

Conclusions:

• The PULL technique for percutaneous gastrostomy is associated with a higher rate of total complications than the PUSH technique.
• Despite differences, both PUSH and PULL gastrostomy methods are considered safe, with most complications being minor and manageable.