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CC BY-NC-ND 4.0 · Endosc Int Open 2025; 13: a25112096
DOI: 10.1055/a-2511-2096
Original article

Hybrid percutaneous endoscopic gastrostomy (Hybrid PEG) improves patient safety by combining pull-through technique with gastropexy

Tobias Horst Kinzel
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Viktoria Reich
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Leonie Schuhmacher
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Christian Bojarski
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Andreas Adler
2   Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Wielfried Veltzke-Schlieker
2   Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Christian Jürgensen
2   Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Frank Tacke
2   Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Britta Siegmund
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Juliane Buchkremer
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Federica Branchi‡
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
,
Christoph Treese  ‡
1   Medizinische Klinik für Gastroenterologie, Infektiologie und Rheumatologie, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Abstract

Background and study aims

The direct puncture technique has been associated with a better safety profile compared with the classical pull-through technique for insertion of a percutaneous endoscopic gastrostomy (PEG). In this study, the safety of the hybrid PEG technique, combining gastropexy with the pull-through technique, was analyzed in a large retrospective patient cohort.

Patients and methods

Clinical data from patients undergoing PEG insertion in a high-volume center for endoscopy were included retrospectively between January 2016 and December 2021. Patient characteristics and complication rates were correlated in univariate and multivariate analyses.

Results

Data from 351 patients undergoing PEG insertion with the hybrid PEG technique were compared with 145 procedures with the direct puncture technique and 1073 procedures with the pull-through technique. In the group where gastropexy was performed (hybrid PEG and direct puncture), we could not find any significant differences in frequency of major and minor complications. Comparing the pull-through technique with the gastropexy group, we detected a five-fold higher major complication rate and a doubled minor complication rate for the pull-through technique. Multivariate analysis confirmed the protective role of gastropexy, with an odds ratio of 0.166 (0.084–0.329; P < 0.001) for major complications.

Conclusions

Hybrid PEG and direct puncture are equally safe PEG insertion techniques, with significantly better safety profiles than the pull-through technique. Despite the retrospective design of the study, these results suggest preferential use of hybrid PEG due to handling.

Keywords

Endoscopy Upper GI Tract - Gastrostomy and PEJ - Quality and logistical aspects - Performance and complications

Supplementary Material



Publication History

Received: 23 June 2024

Accepted after revision: 21 November 2024

Accepted Manuscript online:
07 January 2025

Article published online:
26 February 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Bibliographical Record
Tobias Horst Kinzel, Viktoria Reich, Leonie Schuhmacher, Christian Bojarski, Andreas Adler, Wielfried Veltzke-Schlieker, Christian Jürgensen, Frank Tacke, Britta Siegmund, Juliane Buchkremer, Federica Branchi, Christoph Treese. Hybrid percutaneous endoscopic gastrostomy (Hybrid PEG) improves patient safety by combining pull-through technique with gastropexy. Endosc Int Open 2025; 13: a25112096.
DOI: 10.1055/a-2511-2096
 

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