Outcomes of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy tube insertion at a tertiary hospital

Nauze, Richard La; Collins, Kathryn K.; Lyon, Stuart M.; Bailey, Michael; Kemp, William; Nyulasi, Ibolya; Roberts, Stuart K.

doi:10.1016/j.clnme.2012.05.001

Cited by 18 publications

(20 citation statements)

References 16 publications

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“…We identified 828 citations through the electronic database search, and 445 citations remained after duplicates were removed. Initial screening of the titles and abstracts resulted in the exclusion of 414 citations, and full texts of the remaining 31 citations were reviewed in detail 891617181920212223242526272829303132333435363738394041424344. An additional 16 citations were excluded after reviewing the full articles, for the following reasons: duplicated reports,424344 noncomparative studies,37 studies with RIG placement after failure of PEG,2535 no data present on 30-day mortality,294041 no reported case of 30-day mortality,192730343638 and review articles 1721.…”

Section: Resultsmentioning

confidence: 99%

“…An additional 16 citations were excluded after reviewing the full articles, for the following reasons: duplicated reports,424344 noncomparative studies,37 studies with RIG placement after failure of PEG,2535 no data present on 30-day mortality,294041 no reported case of 30-day mortality,192730343638 and review articles 1721. Fifteen published studies including two RCTs1639 and 13 NRCTs891920222324262831323342 were included in the final analysis.…”

Section: Resultsmentioning

confidence: 99%

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Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

et al. 2016

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Background/AimsA percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG.MethodsMajor electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0.ResultsFifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted.ConclusionsThe present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

et al. 2016

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“…Previous literature has suggested the safety and efficacy of fluoroscopic gastrostomies with comparable complication and failures rates to endoscopic surgery. 7,9,10,[12][13][14][15][16][17] An early randomized control trial by Hoffer et al evaluating 135 gastrostomy patients (66 fluoroscopic, 69 endoscopic) showed higher success rates and fewer incidences of postoperative complications (mainly in incidence of pneumonia) in the fluoroscopic cohort. 7 A more recent, retrospective, single-institution study by Allen et al evaluating the two gastrostomy approaches in patients with amyotrophic lateral sclerosis (ALS) showed significantly lower incidences of tube failure and postoperative aspiration in the fluoroscopic group compared with endoscopic group (1.9 vs. 15.7% failure; 0 vs. 10.5% postoperative aspiration).…”

Section: Discussionmentioning

confidence: 99%

Fluoroscopic and Endoscopic Gastrostomy Tube Placement: Regional Variation and Their Prevalence

Khalid

Gazal

et al. 2019

J Clin Interv Radiol ISVIR

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Objective This study aims to assess the regional variation and overall longitudinal prevalence of approaches to gastrostomy tube placement in patients covered by Medicare or Medicaid. Background Gastrostomy tubes are most commonly inserted endoscopically given the approaches’ demonstrated safety, success, and patient outcomes as compared with laparoscopic approaches. Recently, the growth of interventional radiology services has provided patients with an alternative percutaneous approach. The safety and efficacy of this approach as opposed to endoscopic approaches has yet to be determined. Methods From 2005 to 2014, Medicare Standard Analytic Files derived from Medicare parts A and B, which contain 100% of inpatient and outpatient facility records billed to Medicare, were retrospectively analyzed. Age, sex, year of placement, region, comparative quarterly ratio, regional cost variation, and overall financial cost were compared between both cohorts. Results Our population included a total of 336,021 patients; of those, 30,327 patients underwent fluoroscopic guided procedures, and 305,694 patients underwent endoscopic procedures. Age (p < 0.001), region (p = 0.043), and year of placement (p < 0.001) varied significantly between these populations. Fluoroscopic-guided procedures were found to have a statistically significantly lower average cost of treatment compared with endoscopic gastrostomies ($2,018.62 vs. $2,471.33, respectively, p = 0.03). Conclusion This study demonstrates an increasing prevalence of fluoroscopically placed gastrostomy tubes as compared with those placed endoscopically.

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“…The morbidity is significantly higher in patients who are hospitalized, have diabetes, or are on long‐term corticosteroids or chronically malnourished 61 , 62 . Procedural complication rates are reported between 1.5% and 5%, 63 – 65 whereas postprocedure complications range from 4%–23.8% 55 , 62 , 66 – 69 and again are similar between the 2 techniques 70 …”

Section: Complicationsmentioning

confidence: 92%

Feeding Tube Placement

et al. 2012

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Feeding tube placement for enteral nutrition (EN) support is widely used in both critically ill and stable chronically ill patients who are unable to meet their nutrition needs orally. Nasal or oral feeding tubes can be performed blindly at the bedside or with fluoroscopic or endoscopic guidance into the stomach or small bowel. Percutaneous feeding tubes are used when EN support is required for longer periods (>4-6 weeks) and are most commonly placed endoscopically or radiographically. Although generally safe and effective, there is a wide spectrum of known complications associated with feeding tube placement. Errors made at the time of feeding tube placement can result in a number of these procedural and postprocedural complications. In many cases, a single error at the time of placement can result in numerous complications. A thorough knowledge of these errors and avoiding them in practice will decrease iatrogenic complications in a vulnerable population. In addition, early recognition and management of complications will further minimize morbidity and even mortality in enteral feeding tube placement. This article reviews the common errors leading to complications of enteral feeding tube placement and their prevention and management.

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Outcomes of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy tube insertion at a tertiary hospital

Cited by 18 publications

References 16 publications

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Fluoroscopic and Endoscopic Gastrostomy Tube Placement: Regional Variation and Their Prevalence

Feeding Tube Placement

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