S592 Outcomes and Complications of Radiologic Gastrostomy vs Percutaneous Endoscopic Gastrostomy for Enteral Feeding - An Updated Systematic Review and Meta-Analysis

Abstract

Introduction: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Our aim was to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes. Methods: A systematic review was conducted using Medline, Embase, and Cochrane library databases until December 21, 2021. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using comprehensive meta-analysis software.Results: The initial search revealed 819 studies. Of these, 41 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,091 total patients, 194,350 received PRG and 276,741 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (OR: 1.220, 95% CI: 1.162-1.282, I2554.2%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI:1.184-4.2 and OR: 2.612, 95% CI: 1.917-3.56 respectively). Perforation, peritonitis, bleeding, and infectious complications were also higher with PRG than PEG, although this was not statistically significant on sensitivity analysis. There was no significant difference in the risk of aspiration pneumonia. (Figure ) Conclusion: This systematic review and meta-analysis comparing PRG, and PEG outcomes found higher odds of 30-day mortality, tube leakage, and tube dislodgement with PRG compared to PEG. Rates of bleeding, perforation, infectious complications, and peritonitis were significantly higher with PRG than with PEG, but these results did not achieve statistical significance in a sensitivity analysis. Our metaanalysis has the following strengths: systematic literature search with well-defined inclusion criteria, the inclusion of all available studies in the current literature, careful exclusion of redundant studies, highquality studies with detailed data extraction, and rigorous study quality evaluation. Our pooled rates are calculated from 471,091 patients, a very robust Figure . In summary, PRG is associated with higher 30-day mortality and gastrostomy tube-related complications than PEG. Additional studies, particularly large RCTs, are warranted.[0592] Figure 1. Mortality forest plot.

Safety and Efficacy of Stoma Site Selection in CT-guided Percutaneous Gastrostomy: A Retrospective Analysis

“…Tube dislodgement after percutaneous gastrostomy can be caused by various factors. Some studies suggest that the rate of tube dislodgement is higher with the PRG approach [4]. However, this study found that the overall risk of dislodgement was lower than that reported by Vidhya [21], with similar risk between the rectus abdominis and intercostal regions.…”

“…Currently available research primarily compares the clinical outcomes of PRG and PEG. The success rates of these two methods are comparable; however, higher rates of tube leakage and tube dislodgement have been noted after PRG [4]. There is no signi cant difference between the two procedures in terms of the rate of bleeding or infection around the stoma, but PRG is associated with a higher rate of adverse events such as colon perforation and peritonitis [5,6].…”

Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy for enteral feeding: A systematic review and meta‐analysis

“…13 However, PRG tube diameters are thinner than PEG tubes, and they are secured using a balloon retention system, increasing the risk of tube obstruction and tube dislodgement. 18 Additionally, PRG requires a dedicated fluoroscopy suite, which may not be readily available. 13 Previous systematic reviews and meta-analyses comparing the efficacy and safety of PRG vs PEG predominantly relied on observational studies and yielded conflicting results.…”

“…13 Previous systematic reviews and meta-analyses comparing the efficacy and safety of PRG vs PEG predominantly relied on observational studies and yielded conflicting results. [17][18][19][20][21] Some studies found that PRG leads to a higher rate of 1-month mortality 18,20 ; major adverse events (AEs), such as peritonitis and colon perforation 18,20 ; and tube problems. [17][18][19] On the other hand, one meta-analysis showed higher technical success with PRG.…”

“…[17][18][19][20][21] Some studies found that PRG leads to a higher rate of 1-month mortality 18,20 ; major adverse events (AEs), such as peritonitis and colon perforation 18,20 ; and tube problems. [17][18][19] On the other hand, one meta-analysis showed higher technical success with PRG. 21 Considering the divergence between previous studies, we aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the effectiveness and safety of PRG vs PEG for enteral feeding.…”