Percutaneous Endoscopic Gastrostomy May Be Less Risky for Long-Term Tube Placement

By Lorraine L. Janeczko

October 13, 2021

NEW YORK (Reuters Health) - Percutaneous endoscopic gastrostomy (PEG) appears safer than interventional-radiologist-guided gastrostomy (IRG) for patients who need long-term enteral-tube placement, new research suggests.

"This large nationwide study demonstrated that PEG is associated with a lower incidence of overall adverse outcomes, mechanical dysfunction, and the 30-day mortality than IRG," researchers write in The American Journal of Gastroenterology. "We suggest that PEG should be the initial procedure of choice in patients needing long-term enteral access."

Dr. Divyanshoo R. Kohli of the Kansas City VA Medical Center, in Missouri, and his colleagues queried the VA Informatics and Computing Infrastructure database and found 23,566 patients who underwent PEG and 9,715 who underwent IRG over a roughly ten-year period. They averaged around 70 years of age in both groups.

Patients with stroke, aspiration pneumonia, feeding difficulties, or upper aerodigestive-tract malignancies were more likely to undergo PEG, while those with malignancies of the head, neck, or foregut were more likely to be treated with IRG.

All-cause 30-day mortality was 9.35% patients who received PEG vs. 10.3% in those who received IRG (odds ratio, 0.80; P<0.01). PEG and IRG adverse events included, respectively: perforation of the colon, 0.12% and 0.24% (OR, 0.50; P=0.04); peritonitis, 1.9% and 2.7% (OR, 0.68; P<0.01); and hemorrhage, 1.6% and 1% (OR, 1.47; P<0.01).

Dr. Gobind Anand, an assistant clinical professor and endoscopist at the University of California, San Diego, called it an important study.

"This study is notable for its large size, long follow-up period and use of a robust integrated VA database," he told Reuters Health by email. "These are important findings that may change clinical practice and result in increasing use of endoscopically placed gastrostomy tubes."

Dr. Anand, who was not involved in the study, noted that the its retrospective design is a limitation. "Ideally, randomized controlled studies would be performed to demonstrate true differences in these two techniques."

Dr. Danny Issa, an assistant professor of medicine and an interventional and bariatric endoscopist at the David Geffen School of Medicine at UCLA, noted in an email to Reuters Health that, "Prior to this study, limited data were available on comparing safety and adverse outcomes between gastrostomy techniques."

Because the study suggests "that PEG be considered the first procedure of choice in patients requiring gastric or enteral feeding, efforts should be made to ensure the availability of this intervention in the inpatient setting," said Dr. Issa, who also was not part of the research.

Dr. Rishi D. Naik, an assistant professor in medicine and gastroenterologist at Vanderbilt University Medical Center in Nashville, Tennessee, explained that "both approaches for gastrostomy placement are safe but this study highlights that technical differences in the procedure may favor a physician’s preference for PEG vs. IRG."

"Overall, gastrostomy-tube placement is a technically safe and effective procedure," he told Reuters Health by email, "but the adverse outcomes seen in this retrospective study are likely more reflective of the indication for PEG vs. IRG, which the study does not control for."

"Prospective studies could prove useful," added Dr. Naik, who was not involved in the research. "However, there will be residual confounding by indication especially for patients with known malignancy, for which IRG is often preferred to prevent the risk of seeding the tract."

Dr. Kohli was not available for comments.

SOURCE: American Journal of Gastroenterology, online September 10, 2021.