Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study

Abstract

Background and Aims Percutaneous endoscopic gastrostomy (PEG) is indicated for prolonged enteral nutrition. This study aimed to analyze the outcome and to identify potential risk factors for complications in PEG procedures. Methods A single‐center retrospective analysis of the performed PEG procedures during the period January 2010 till January 2020. Results A PEG placement procedure was performed in 854 patients (64.1% male) and was successful in 833 (97.5%). In total, 513 push (61.6%) and 320 pull (38.6%) PEGs were placed. The mean age was 60.7 years, and the median follow‐up was 267 days. The push PEG was associated with peri‐procedural bleeding (P = 0.002) and tube dislodgements (P < 0.001), while the pull PEG was significantly associated with buried bumpers (P < 0.001), infected placement sites (P = 0.019), and granulation tissue formation (P = 0.044). The PEG‐related mortality rate was 0.2%, but the overall 30‐day mortality was 4.0%. Conclusion The current study showed that the push and pull PEG placements are both safe and feasible procedures, with a low PEG‐related mortality. Buried bumpers, infected placement sites, and granulation tissue formation are more often seen in the pull PEG, while the push PEG is associated with periprocedural bleeding and tube dislodgements. These complications should be taken into account and there is a need for a prospective trial to identify superiority between the PEG methods.

Does enteral nutrition through a percutaneous endoscopic gastrostomy, attenuate Helicobacter pylori colonization?: is it worth mentioning?

“…Our study's median PEG exchange duration was 9 months (0.5-6). Similarly, in a study by Bouchiba et al 16 the median follow-up was found to be 8.9 months. In our study, the median age was found to be 83 years (35-96) in the PEG exchange group, while Jung et al 2 reported the mean age of 77 years.…”

Severe Gastrointestinal Bleeding Following Gastrostomy Tube Replacement: A Case of an Unusual Presentation of Enterocutaneous Fistula

“…The most common types of complications include tube dislodgement, granulation tissue formation, local infection, minor bleeding, site leakage, and buried bumper. Significant hemorrhage and intestinal perforation are extremely rare complications [ 5 ].…”

“…In a study of 854 patients undergoing PEG placement (513 with push technique vs. 320 with pull technique), minor bleeding and tube dislodgement were more associated with push technique (6.9% vs. 2.1%, p = 0.002; 11.9% vs. 3.3%, p < 0.001), whereas buried bumper was more frequent in the pull technique (0.4% vs. 7.3%, p < 0.001) [ 5 ]. Major complications were exceptionally rare, and perforation occurred in three patients (all were in the pull technique group).…”

“…However, they are not free of complications. Fortunately, most complications are minor, and many times can be resolved conservatively [ 5 , 6 ]. Major complications such as bleeding, peritonitis, bowel perforation, buried bumper syndrome [ 7 ], and sepsis are rare but can pose a risk of G-tube-associated mortality [ 5 ].…”

“…The push and pull techniques are widely used and associated with very low mortality risk. Each method has different risks and different rates of complications [ 5 , 8 ]. We describe a case of a patient who underwent a seemingly uncomplicated PRG placement a little more than a year ago, who presented with gastrointestinal (GI) bleeding after an uncomplicated routine tube change a day prior.…”