Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications

Abstract

Background and study aims Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications.

Patients and methods A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (≤ 30 days) and late) and success rates.

Results A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2 % for PEG and 97.1 % for PRG (P = 0.001). Procedure-related mortality was 1.7 % in PEG and 0.4 % in PRG (P = 0.113). The 30-day mortality was 10.7 % in PEG and 5.1 % in PRG (P = 0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates.

Tube-related complications were less frequent in PEG, both early (2.7 % vs. 26.4 %, P ≤ 0.001) and late (8.6 % vs. 31.5 %, P ≤ 0.001). The percentage of major complications and infections did not differ.

Conclusions With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.

• References

• 1 Löser C, Aschl G, Hebuterne X. et al. Consensus Statement; ESPEN guidelines on Artificial enteral nutrition - percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005; 24: 848-861
• 2 Itkin M, DeLegge MH, Fang JC. et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). J Vasc Interv Radiol 2011; 22: 1089-1106
• 3 Preshaw RM. A percutaneous method for inserting a feeding gastrostomy tube. Surg Gynecol Obstet 1981; 152: 658-660
• 4 Ho CS, Yee ACN, McPherson R. Complications of surgical and percutaneous nonendoscopic gastrostomy: review of 233 patients. Gastroenterol 1988; 95: 1206-10
• 5 Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Ann Surg 1988; 207: 598-603
• 6 Silas AM, Pearce LF, Lestina LS. et al. Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients. Eur J Radiol 2005; 56: 84-90
• 7 Wollman B, D'Agostino HB. Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance. Am J Roentgenol 1997; 169: 1551-1553
• 8 Wollman B, D'Agostino HB, Walus-Wigle JR. et al. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 1995; 197: 699-704
• 9 Neeff M, Crowder VL, McIvor NP. et al. Comparison of the use of endoscopic and radiologic gastrostomy in a single head and neck cancer unit. ANZ J Surg 2003; 73: 590-593
• 10 Thornton FJ, Fotheringham T, Alexander M. et al. Amyotrophic lateral sclerosis: Enteral nutrition provision - Endoscopic or radiologic gastrostomy?. Radiology 2002; 224: 713-717
• 11 Eze N, Jefford JM, Wolf D. et al. PEG and RIG tube feeding in Head and Neck patients: a retrospective review of complications and outcome. J Eval Clin Pract 2007; 13: 817-819
• 12 Cosentini EP, Sautner T, Gnant M. et al. Outcomes of surgical, percutaneous endoscopic, and percutaneous radiologic gastrostomies. Arch Surg (Chicago, Ill : 1960) 1998; 133: 1076-1083
• 13 Allen JA, Chen R, Ajroud-Driss S. et al. Gastrostomy tube placement by endoscopy versus radiologic methods in patients with ALS: a retrospective study of complications and outcome. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14: 308-314
• 14 La Nauze RJ, Collins K, Lyon S. et al. Outcomes of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy tube insertion at a tertiary hospital. ESPEN J 2012; 7: e144-e148
• 15 Möller P, Lindberg CG, Zilli T. Gastrostomy by various techniques: evaluation of indications, outcome, and complications. Scand J Gastroenterol 2009; 34: 1050-1054
• 16 Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database of Syst Rev 2013; 11: CD005571
• 17 Halpenny DF, Torreggiani WC. The Infectious complications of interventional radiology based procedures in gastroenterology and hepatology. J Gastrointestin Liver Dis 2011; 20: 71-75
• 18 Grant DG, Bradley PT, Pothier DD. et al. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009; 34: 103-112
• 19 Coletti D, Genuit T, Ord R. et al. Metastasis to the percutaneous endoscopic gastrostomy site in the patient with head and neck cancer: a case report and review of the literature. J Oral Maxillofac Surg 2006; 64: 1149-1157
• 20 Zhang L, Dean SA, Furth EE. et al. Metastatic carcinoma to percutaneous endoscopic gastrostomy tube sites. A report of five cases. Am J Clin Pathol 2014; 141: 510-514
• 21 Hawken RM, Williams RW, Bridger MW. et al. Puncture-site metastasis in a radiologically inserted gastrostomy tube: case report and literature review. Cardiovasc Intervent Radiol 2005; 28: 377-380
• 22 Gauderer MW, Ponsky JL, Izant RJ. et al. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872-875
• 23 Sutcliffe J, Wigham A, McEniff N. et al. CIRSE Standards of Practice Guidelines on Gastrostomy. Cardiovasc Intervent Radiol 2016; 39: 973-987
• 24 Chio A. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. J Neurol Neurosurg Psychiatry 2004; 75: 645-647
• 25 McDermott CJ. Gastrostomy in patients with amyotrophic lateral sclerosis (ProGas): A prospective cohort study. Lancet Neurol 2015; 14: 702-709
• 26 Blondet A, Lebigot J, Nicolas G. et al. Radiologic versus endoscopic placement of percutaneous gastrostomy in amyotrophic lateral sclerosis: multivariate analysis of tolerance, efficacy, and survival. J Vasc Interv Radiol 2010; 21: 527-533
• 27 Rio A, Ellis C, Shaw C. et al. Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease. J Hum Nutr Diet 2010; 23: 408-415
• 28 del Aguila MA, Longstreth Jr. WT, McGuire V. et al. Prognosis in amyotrophic lateral sclerosis: a population-based study. Neurology 2003; 60: 813-819
• 29 McAllister P, MacIver C, Wales C. et al. Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates. Br J Oral Maxillofac Surg 2013; 51: 714-718
• 30 Rustom IK, Jebreel A, Tayyab M. et al. Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients. J Laryngol Otol 2006; 120: 463-466
• 31 Registry NC. Cijfers over Kanker [Numbers on cancer]. 2015 (cited 2017 August)
• 32 Lichtman JH, Jones SB, Wang Y. et al. Seasonal variation in 30-day mortality after stroke: teaching versus nonteaching hospitals. Stroke 2013; 44: 531-533
• 33 Abuksis G, Mor M, Segal N. et al. Percutaneous endoscopic gastrostomy: high mortality rates in hospitalized patients. Am J Gastroenterol 2014; 95: 129-132
• 34 Zopf Y, Konturek P, Nuernberger A. et al. Local infection after placement of percutaneous endoscopic gastrostomy tubes: A prospective study evaluating risk factors. Can J Gastroenterol 2008; 22: 987-991
• 35 Barbosa M, Magalhaes J, Marinho C. et al. Predictive factors of early mortality after percutaneous endoscopic gastrostomy placement: The importance of C-reactive protein. Clin Nutr ESPEN 2016; 14: 19-23
• 36 Richter-Schrag HJ, Richter S, Ruthmann O. et al. Risk factors and complications following percutaneous endoscopic gastrostomy: A case series of 1041 patients. Can J Gastroenterol 2011; 25: 201-206
• 37 Lang A, Bardan E, Chowers Y. et al. Risk factors for mortality in patients undergoing percutaneous endoscopic gastrostomy. Endoscopy 2004; 36: 522-526
• 38 Lang EK, Allaei A, Abbey-Mensah G. et al. Percutaneous radiologic gastrostomy: results and analysis of factors contributing to complications. J La State Med Soc 2013; 165: 254-259
• 39 Elliott LA, Sheridan MB, Denyer M. et al. PEG - Is the E Necessary? a comparison of percutaneous and endoscopic gastrostomy. Clin Radiol 1996; 51: 341-344
• 40 Galaski A, Peng WW, Ellis M. et al. Gastrostomy tube placement by radiological versus endoscopic methods in an acute care setting: A retrospective review of frequency, indications, complications and outcomes. Can J Gastroenterol 2009; 23: 109-114
• 41 Laskaratos FM, Walker M, Walker M. et al. Predictive factors for early mortality after percutaneous endoscopic and radiologically-inserted gastrostomy. Dig Dis Sci 2013; 58: 3558-3565
• 42 Laasch HU, Wilbraham L, Bullen K. et al. Gastrostomy insertion: comparing the options—PEG, RIG or PIG?. Clin Radiol 2003; 58: 398-405
• 43 Wollman B, D'Agostino HB, Walus-Wigle JR. et al. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature. Radiology 1995; 197: 699-704
• 44 Strijbos D, Hofstede J, Keszthelyi D. et al. Percutaneous endoscopic gastrostomy under conscious sedation in patients with amyotrophic lateral sclerosis is safe: an observational study. Eur J Gastroenterol Hepatol 2017; 29: 1303-1308
• 45 MacLean AA, Alvarez NR, Davies JD. et al. Complications of percutaneous endoscopic and fluoroscopic gastrostomy tube insertion procedures in 378 patients. Gastroenterol Nurs 2007; 30: 337-341
• 46 Neeff M, Crowder VL, McIvor NP. et al. Comparison of the use of endoscopic and radiologic gastrostomy in a single head and neck cancer unit. ANZ J Surg 2003; 73: 590-593
• 47 Fan AC, Baron TH, Rumalla A. et al. Comparison of direct percutaneous endoscopic jejunostomy and PEG with jejunal extension. Gastrointest Endosc 2002; 56: 890-894
• 48 Palmer LB, McClave SA, Bechtold ML. et al. Tips and tricks for deep jejunal enteral access: modifying techniques to maximize success. Curr Gastroenterol Rep 2014; 16: 409
• 49 DiSario JA, Foutch PG, Sanowski RA. Poor results with percutaneous endoscopic jejunostomy. Gastrointest Endosc 1990; 36: 257-260
• 50 Cappell MS. Risk factors and risk reduction of malignant seeding of the percutaneous endoscopic gastrostomy track from pharyngoesophageal malignancy: a review of all 44 known reported cases. Am J Gastroenterol 2007; 102: 1307-1311
• 51 Sinapi I, Navez B, Hamoir M. et al. Seeding of the percutaneous endoscopic gastrostomy site from head and neck carcinoma: case report and review of the literature. Head Neck 2013; 35: E209-E212
• 52 Barkmeier JM, Trerotola SO, Wiebke EA. et al. Percutaneous Radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis. CardioVasc Intervent Radiol 1998; 21: 324-328
• 53 Wilcox CM. Gastrostomy tubes and quality of life: is the glass half empty or half full?. Clin Gastroenterol Hepatol 2017; 15: 998-999
• 54 Gomes Jr. CA, Andriolo RB, Bennett C. et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev 2015; 05: CD008096