Predictive Factors for Early Mortality After Percutaneous Endoscopic and Radiologically-Inserted Gastrostomy

Abstract

Our data suggest that PEG should be the procedure of choice when considering gastrostomy insertion and RIG should be reserved as a second-line approach for cases in which PEG is technically difficult or contraindicated.

Antibacterial gauzes are effective in preventing infections after percutaneous endoscopic gastrostomy placement

“…A C-reactive protein greater than 21.5 mg/l was found to increase the risk of mortality [30]; a low albumin count (both below 28 g/l [31] as well as below 31.5 g/l [30]) was also found to be a risk factor. Placement of the internal bolster at the upper body of the stomach, high leukocyte count, and an inexperienced endoscopist were also associated with a higher risk of complications in the literature [31]. The risk of developing a wound infection in particular is increased in patients with liver cirrhosis, malignancy, and exposure to radiotherapy [26].…”

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

“…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.…”

“…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.…”

“…Radiologically-inserted gastrostomy (RIG) was also introduced in 1981 and has been used as an alternative to PEG for enteral feeding with a high rate of technical success under local anesthesia 3. Although PEG and RIG are both considered minimally invasive, they are associated with considerable early mortality (30-day mortality), which has been reported as 5.8% to 28% for PEG and 1% to 40% for RIG 456789. Furthermore, various complications such as wound infections, hemorrhage, hematoma formation, aspiration pneumonia, or gastric perforation may develop after gastrostomy.…”

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“…With PEG, a prospective study (n = 484) reported a high incidence of complications at 2 and 8 weeks of 39 % and 27 %, respectively [467]. A retrospective study [468] compared PEG and RIG insertions and found PEG to be superior with regard to early mortality, mainly from pneumonia. US guidance in experienced hands allows the identification of the position of (a) the stomach, (b) the liver, and (c) in most instances, the transverse colon.…”