Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

Abstract

Objective To compare indications, success rates and complications of pull [P] and introducer [I] techniques for percutaneous endoscopic gastrostomy (PEG). Methods In this retrospective study, inpatients who underwent primary PEG tube insertion between January 2015 and February 2020 at the Endoscopy Center of the First Affiliated Hospital of Fujian Medical University were included. Results A total of 103 inpatients were included in this study (P group, n = 67; I group, n = 36). The rates of tube replacement within first six months in the P and I groups were 1.5% and 11.1%, respectively (P = 0.049). The most common primary indication of PEG was malignancy. The proportion of patients with esophageal cancer was significantly lower in the P group (24.4% vs 54.2%, P = 0.015). No significant difference was found in the overall, major, or minor complications between the two groups. In patients with esophageal stenosis, the pull method was a risk factor for complications (P = 0.03; odds ratio [OR] = 12, 95% confidence interval [CI]: 1.164–123.684). Logistic regression analysis showed that the risk factors for major and minor complications were the admission-to-gastrostomy interval (OR = 1.078, 95% CI: 1.016–1.145, P = 0.014) and lack of antibiotic use (OR = 4.735, 95% CI: 1.247–17.979, P = 0.022), respectively. Conclusion Both PEG techniques have high clinical success rates. The introducer technique is more suitable for patients with esophageal stricture, which has lower minor complications, but higher rate of tube replacement compared to the pull technique. Use of antibiotics may reduce minor complications following PEG. Early PEG insertion may help to reduce post-PEG major complications.

Indicações e comparação entre as vias alimentares cirúrgicas por ostomias em pacientes que necessitam de dieta enteral

“…Na maioria dos a alimentação enteral via GEP é a modalidade de escolha (COLLETIER et al, 2023;NISHIWAKI et al, 2021;LI et al, 2022;GROTE et al, 2021;WEIMANN A et al;NUNES et al, 2020;MATSUTANI et al, 2016). Essa preferência se dá por ter menos contraindicações, menor tempo de procedimento e menor incidência de complicações severas, se comparada à gastrostomia cirúrgica (LI et al, 2022). Além disso, a GEP está relacionada à melhoria de qualidade de vida para os pacientes com indicação (MORROS-GONZÁLEZ; VARGAS-RÚBIO; OVALLE, 2021).…”

“…Sua administração é feita por meio de um tubo que pode ser passado pelo nariz, sendo então chamado de tubo nasogástrico ou nasoentérico; pela boca, os tubos orogástricos, ou cirurgicamente fixados em região abdominal através de ostomias, seja gastrostomia ou jejunostomia que fará a suplementação diretamente no estômago ou jejuno, respectivamente (SANTOS et al, 2011;LI et al, 2022).…”

“…Para pacientes que precisam de suporte nutricional enteral por um período mais prolongado, superior a quatro semanas, bem como para aqueles portadores de neoplasia maligna irressecável do trato gastrointestinal que comprometem a deglutição e o apetite, pode ser indicada a colocação de tubos de alimentação em diferentes partes do trato gastrointestinal, feita através de ostomias (LI et al, 2022;GROTE et al, 2021;WEIMANN et al, 2017;GKOLFAKIS, ARVANITAKIS, 2021).…”