Percutaneous endoscopic gastrostomy by “push” method with gastropexy or “pull-through” method: is there a difference regarding peristomal infections?

Aims Enteral nutrition is crucial for managing patients with swallowing difficulties, particularly those with head and neck cancers or neurological disorders. Percutaneous endoscopic gastrostomy (PEG) has become the standard method for providing enteral nutrition, with two primary techniques: the “pull-through” technique and the “push” method. Peristomal infections are a common complication following PEG placement, impacting recovery and healthcare costs. The aim of this trial was to evaluate which technique to place a PEG is superior regarding peristomal infections.

Methods This prospective, randomized controlled study included patients aged 18 and older who underwent PEG insertion at the University Hospital Frankfurt between June 2020 and July 2022. Patients were randomized into two groups: PEG placement by the “push” method with gastropexy using an introducer system (“push”) or by the “pull-through” method (“pull”). Key outcomes, including peristomal infection rates after short term (up to 30 days) and after long term (at one year) as well as overall procedure times were compared between both groups.

Results A total of 122 patients were enrolled, with 61 in each group. The “push” method required significantly more time for placement than the “pull-through” method (median 18 vs. 13 minutes; p=0.001). Short-term peristomal infection rates were comparable (16, 26% in “pull” vs. 18, 30% in “push”; 0.84); however, the pull-through technique had higher long-term infection rates (10, 16% vs. 3, 5% patients requiring systemic antibiotics; 0.04). Additionally, administration of antibiotic prophylaxis prior to PEG placement was identified as the only independent predictor for post-procedural peristomal infections (p=0.04).

Conclusions The “push” method of PEG placement showed a trend toward lower short-term infection rates and significantly lower long-term infection rates. It warrants further evaluation as an alternative first-line technique, particularly for patients at high risk for peristomal infections, such as those who are immunosuppressed. However, it is not the type of PEG placement that seems to have the greatest impact but rather the administration of antibiotic prophylaxis prior to the procedure that significantly lowers the rate of peristomal infections.

Publication History

Article published online:
27 March 2025