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Safety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment

Published:September 12, 2020DOI:https://doi.org/10.1016/j.gie.2020.09.012

      Background and Aims

      A gastrostomy tube is often required for inpatients requiring long-term nutritional access. We compared the safety and outcomes of 3 techniques for performing a gastrostomy: percutaneous endoscopic gastrostomy (PEG), fluoroscopy-guided gastrostomy by an interventional radiologist (IR-gastrostomy), and open gastrostomy performed by a surgeon (surgical gastrostomy).

      Methods

      Using the Nationwide Readmissions Database, we identified hospitalized patients who underwent a gastrostomy from 2016 to 2017. They were identified using the International Classification of Diseases, 10th Revision, Procedure Coding System. The selected patients were divided into 3 cohorts: PEG (0DH64UZ), IR-gastrostomy (0DH63UZ), and open surgical gastrostomy (0DH60UZ). Adjusted odds ratios for adverse events associated with each technique were calculated using multivariable logistic regression analysis.

      Results

      Of the 184,068 patients meeting the selection criteria, the route of gastrostomy tube placement was as follows: PEG, 16,384 (53.7 ± 29.0 years); IR-gastrostomy, 154,007 (67.2 ± 17.5 years); and surgical gastrostomy, 13,677 (57.9 ± 24.3 years). Compared with PEG, the odds for colon perforation using IR-gastrostomy and surgical gastrostomy, respectively, were 1.90 (95% confidence interval [CI], 1.26-2.86; P = .002) and 6.65 (95% CI, 4.38-10.12; P < .001), for infection of the gastrostomy 1.28 (95% CI, 1.07-1.53; P = .006) and 1.61 (95% CI, 1.29-2.01; P < .001), for hemorrhage requiring blood transfusion 1.84 (95% CI, 1.26-2.68; P = .002) and 1.09 (95% CI, .64-1.86; P = .746), for nonelective 30-day readmission 1.07 (95% CI, 1.03-1.12; P = .0023) and 1.13 (95% CI, 1.06-1.2; P = .0002), and for inpatient mortality 1.09 (95% CI, 1.02-1.17; P = .0114) and 1.55 (95% CI, 1.42-1.69; P < .0001).

      Conclusions

      Placement of a gastrostomy tube (PEG) endoscopically is associated with a significantly lower risk of inpatient adverse events, mortality, and readmission rates compared with IR-gastrostomy and open surgical gastrostomy.

      Graphical abstract

      Abbreviations:

      ICD-10-PCS (International Classification of Diseases, 10th Revision, Procedure Coding System), ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification), IR (interventional radiologist)
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      Linked Article

      • Percutaneous endoscopic gastrostomy: after 40 years
        Gastrointestinal EndoscopyVol. 93Issue 5
        • Preview
          PEG was first performed in infants in the spring of 1979.1 Soon afterward, it was used in adults. A year later, the technique was presented at the annual meeting of the American Society for Gastrointestinal Endoscopy.2 Since that time, PEG has become an accepted and widely practiced method for achieving enteral access. The method was first used to establish a minimally invasive means to provide feedings in neurologically impaired patients, avoiding the need for laparotomy, which was required for traditional gastrostomy.
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