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Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature
B Wollman1, H B D'Agostino, J R Walus-Wigle
1Department of Radiology, University of California San Diego Medical Center 92103-8756, USA.
Purpose:
To evaluate the effectiveness and safety of radiologic, percutaneous endoscopic (PEG), and surgical gastrostomy.
Materials And Methods:
This project involved 5,752 patients (837 patients underwent radiologic gastrotomy; 4,194, PEG; and 721, surgical gastrostomy). Seventy-two (47 male, 25 female; age range, 12-94 years) underwent gastrostomy within 1 year in this series (radiologic gastrostomy, n = 33; PEG, n = 35; surgical gastrostomy, n = 4). A meta-analysis of 5,680 additional cases from literature published from 1980 to the present was also performed.
Results:
Rates of successful tube placement were higher for radiologic gastrostomy than for PEG in our series and in the meta-analysis (99.2% vs 95.7%, P < .001). Major complications occurred less frequently after radiologic gastrostomy in our series and in the meta-analysis (5.9% vs 9.4% for PEG and 19.9% for surgery, P < .001). Thirty-day procedure-related mortality rates were highest for surgery (2.5% vs 0.3% for radiologic gastrostomy and 0.53% for PEG, P < .001).
Conclusion:
Radiologic gastrostomy is associated with a higher success rate than is PEG and less morbidity than either PEG or surgery.