Global Safety Outcomes of Endoscopic Gastrostomy Tube Placement Compared With Radiologic and Surgical Gastrostomy

Gastrostomy tube (GT) placement is essential for patients requiring long-term enteral access, but the relative safety of percutaneous endoscopic gastrostomy (PEG), radiologic placement (IR), and surgical gastrostomy across global populations remains uncertain. Previous large-scale studies, such as Kohli and colleagues, demonstrated favorable outcomes for PEG in US cohorts; however, their external validity to international health care systems is unclear.

We conducted a retrospective cohort study using the TriNetX Global Research Network, including 146 health care organizations worldwide (2005-2024). Hospitalized patients undergoing GT placement through PEG, IR, or surgical techniques were identified using ICD-10-PCS codes. After 1:1 propensity score matching by demographics and comorbidities, outcomes were compared across groups using odds ratios (ORs) with 95% CIs. Primary outcomes included mortality, transfusion, colon perforation, and infection; secondary outcomes included discharge disposition, device-related complications, and SNF/rehab placement.

After matching, PEG was associated with significantly lower odds of transfusion (OR: 0.844, P = 0.001), non-home discharge (OR: 0.514, P < 0.001), and SNF placement (OR: 0.491, P < 0.001) compared with IR, with no significant differences in infection or mortality. Compared with surgical gastrostomy, PEG showed lower risks of colon perforation (OR: 0.144, P < 0.001), transfusion (OR: 0.635, P < 0.001), and mortality (OR: 0.724, P < 0.001), though higher risks of gastrostomy infection (OR: 1.266, P = 0.001) and mechanical complications (OR: 1.129, P = 0.001). IR placement demonstrated lower perforation, transfusion, and mortality risks compared with surgery but higher likelihood of non-home discharge and SNF placement.

In this global cohort, PEG consistently demonstrated superior safety and patient-centered outcomes compared with IR and surgical gastrostomy, supporting its role as the preferred method of GT placement when feasible. These findings reinforce the need for expanded endoscopic infrastructure and training in health care systems worldwide.