Endoscopic safer than radiological gastrostomy tube placement

Percutaneous endoscopic gastrostomy (PEG) leads to fewer adverse outcomes and lower 30-day mortality than interventional radiologist-guided gastrostomy (IRG), according to a study.

From 2011 through 2021, the investigators selected patients who underwent PEG or IRG using the VA Informatics and Computing Infrastructure database and the Current Procedural Terminology and International Classification of Diseases (ICD) codes. They identified comorbidities using ICD codes and calculated adjusted odds ratio (OR) for adverse events using multivariate logistic regression analysis.

Overall, 23,566 patients (mean age 70.7 years) underwent PEG and 9,715 (mean age 69.6 years) IRG. Some of the common indications for PEG vs IRG were stroke (6.8 percent vs 5.3 percent; p<0.01), aspiration pneumonia (10.9 percent vs 6.8 percent; p<0.001), feeding difficulties (9.8 percent vs 6.3 percent; p<0.01), and upper aerodigestive tract malignancies (58.8 percent vs 79.8 percent; p<0.01).

More patients underwent IRG than PEG (p<0.001) across all subtypes of malignancies of the head and neck and foregut.

PEG correlated with significantly lower all-cause 30-day mortality and overall incidence of adverse events compared with IRG: all-cause 30-day mortality (9.35 percent vs 10.3 percent; OR, 0.80, 95 percent confidence interval [CI], 0.74–0.87; p<0.01), perforation of the colon (0.12 percent vs 0.24 percent; OR, 0.50, 95 percent CI, 0.29–0.86; p=0.04), peritonitis (1.9 percent vs 2.7 percent; OR, 0.68, 95 percent CI, 0.58–0.79; p<0.01), and haemorrhage (1.6 percent vs 1 percent; OR, 1.47, 95 percent CI, 1.18–1.83; p<0.01).

“A gastrostomy is generally performed in patients who are unable to maintain volitional intake of food,” the investigators said.