Safety and Outcomes of Endoscopic and Radiologic Guided Placement of Percutaneous Gastrostomy Tube: A US...

Gastrostomy is a widely utilized modality for long-term enteral nutrition, performed mainly through endoscopic or radiologic approaches, as they are less invasive than surgical approach. While both techniques are effective, their complications and outcomes remain under investigation. This study aims to compare the incidence of adverse events of percutaneous endoscopic gastrostomy (PEG) and interventional radiological-guided gastrostomy (IR-G) using large multicenter database.

Study cohorts were identified using TriNetX US Collaborative Network database. Current procedural terminology (CPT) codes were utilized to identify two cohortss: PEG versus IR-G. Propensity score matching was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 30 days of the procedure and included adverse events following gastrostomy.

Total of 160,064 patients were included in our study. After propensity score matching, 51,107 patients were included in each group. Compared with PEG, IR-G group had significantly higher odds of gastrostomy infections (1.07% vs. 0.88%; aOR 1.21; 95% CI: 1.07-1.37; P < 0.01), gastrostomy malfunctions (5.16% vs. 3.06%; aOR 1.72; 95% CI: 1.58-1.80; P < 0.01), and overall gastrointestinal (GI) bleeding (1.23% vs. 1.09%; aOR 1.13; 95% CI: 1.01-1.28; P = 0.04); however, no statistical differences were observed for gastrostomy-related hemorrhage. The odds of aspiration pneumonia were lower in IR-G group patients (2.85% vs. 3.19%; aOR 0.89; 95% CI: 0.82-0.96; P < 0.01). Overall mortality rates were higher in the IR-G group patients (10.06% vs. 9.19%; aOR 1.11; 95% CI: 1.05-1.14; P < 0.01). Complications such as perforations and peritonitis were not significantly different between the 2 groups.

Percutaneous endoscopic gastrostomy placement is associated with lower risk of gastrostomy malfunctions, infections, and overall GI bleeding compared with radiological-guided gastrostomy placement, highlighting superior safety outcomes. When feasible and expertise is available, endoscopic approach should be used as the primary method for gastrostomy tube placement.