Safety and effectiveness of radiologic and endoscopic percutaneous gastrostomy placement: A randomized study

Abstract

Background: Gastrostomy tubes placed radiologically, endoscopically or surgically facilitate long-term home enteral nutrition (HEN). Patient-specific clinical factors may affect placement techniques, confounding direct comparisons between radiologically inserted gastrostomy (RIG) and percutaneous endoscopic gastrostomy (PEG) outcomes.This study sought to evaluate the differences in clinical outcomes in patients undergoing gastrostomy tube placement by interventional radiologists or gastroenterologists.Methods: A single-center prospective trial randomizing patients initiating HEN to RIG or PEG was conducted between March 2018 and June 2021. Patients were followed until the time of gastrostomy removal or until 9 months after tube placement. Tracked complications included peritonitis, abscess, bleeding, bowel perforation, and tube occlusion, malposition, or damage. Periprocedural pain rating and quality of life (QoL) surveys were collected.Results: Forty-two patients were randomized to RIG or PEG. Twenty patients underwent RIG (mean age, 63.0 ± 11.7 years; 85% male; 95% with head and neck cancer) and 22 patients underwent PEG (mean age, 66.3 ± 10.9 years; 81.8% male; 90.9% with head and neck cancer). RIG and PEG groups had 4.18 ± 5.49 and 2.80 ± 5.82 complications per 1000 HEN days, respectively (P = 0.357). The most frequent complications were tube malposition and abscess formation for the RIG and PEG groups, respectively. No major complications occurred in either group.There was no difference in the average of pain ratings in all pain inventory components across both groups. Both groups reported improvement in overall QoL after gastrostomy tube placement (P = 0.532). Conclusion:RIG is noninferior to PEG regarding complication rates, pain, and QoL when compared in a prospective randomized fashion.

Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy for enteral feeding: A systematic review and meta‐analysis

“…After removing duplicates (n = 63), we screened 329 studies. Of those, 10 studies were fully reviewed, from which we included 5 RCTs, [29][30][31][32][33] encompassing a total of 544 patients. Table S1 describes the excluded studies after full-text review and the reasons for exclusion.…”

“…Technical success was reported by all the included RCTs, [29][30][31][32][33] encompassing 544 patients. The PRG group exhibited a pooled 2 and 3A).…”

“…The five studies [29][30][31][32][33] reported overall all-cause mortality rates. The PRG group had a pooled estimated overall mortality rate of 15% (95% CI = 11%-19%; I² = 77%), and the PEG group demonstrated an overall mortality rate of 12% (95% CI = 9%-16%; I² = 17%).…”

“…The five studies [29][30][31][32][33] reported the overall AE rates. The PRG group exhibited a pooled estimated AE rate of 53% (95% CI = 47%-59%; I² = 93%), and the PEG group demonstrated an AE rate of 50% (95% CI = 44%-56%; I² = 95%).…”

Home enteral nutrition: A descriptive study

“…With percutaneous placement, there is also a debate regarding endoscopic‐ or radiologic‐guided placement, with some studies demonstrating higher complications with radiologic placement 18,19 . We recently published results of a prospective trial randomizing patients that initiated HEN treatment to either endoscopic or radiologic placement of percutaneous gastrostomy tube 20 . There was no significant differences in complications between the groups, although the radiologically placed tubes did have higher rates of malposition, felt to be caused by the use of balloon tubes vs bumper tubes with endoscopically placed tubes.…”