Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Abstract

Background/AimsA percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG.MethodsMajor electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0.ResultsFifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38–0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%–6.9%) and that of RIG was 10.5% (95% CI, 6.8%–14.3%). No publication bias was noted.ConclusionsThe present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.

Percutaneous Endoscopic Transgastric Jejunostomy (PEG‐J) Tube Placement for Levodopa‐Carbidopa Intrajejunal Gel Therapy in the Interventional Radiology Suite: A Long‐term Follow‐up

“…There are many studies reporting the efficacy and safety of PEG and RIG. However, the optimal technique for gastrostomy in individuals who have swallowing disturbances or PD remains unknown . A recent Cochrane meta‐analysis evaluating the safety and efficacy of these 2 techniques concluded that current evidence is insufficient to recommend 1 over the other …”

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

“…Nevertheless, although no endoscopy is necessary, RIG usually requires the passage of an NGT, which may be impossible in some cancer patients. Furthermore, few radiology teams seem to have acquired extensive experience with this technique [44][45][46][47][48].…”

National Multicenter and Multiyear Review of Complications Following Fluoroscopic Gastrostomy in Patients Covered by Medicare and Medicaid

“…[8][9][10][11] However, much of the current literature on fluoroscopic gastrostomy, in particular, has been limited to being outside of the United States or performed in a single institution or region. 7,8,[12][13][14][15][16][17][18][19] This study aims to evaluate the complication rates associated fluoroscopically placed gastrostomy tubes nationally in patients covered by Medicare parts A and B in the United States.…”