Direct Percutaneous Endoscopic Gastrostomy Versus Radiological Gastrostomy in Patients Unable to Undergo Transoral Endoscopic Pull Gastrostomy

Overview

Journal Dig Dis Sci

Specialty Gastroenterology

Date 2022 Jun 16

PMID 35708794

Authors

Divyanshoo R Kohli

Craig Smith

Omer Chaudhry

Madhav Desai

Dion DePaolis

Prateek Sharma

Affiliations

Soon will be listed here.

Abstract

Background And Aims: A subset of patients needing long-term enteral access are unable to undergo a conventional transoral "pull" percutaneous endoscopic gastrostomy (PEG). We assessed the safety and efficacy of an introducer-style endoscopic direct PEG (DPEG) and an interventional radiologist guided gastrostomy (IRG) among patients unable to undergo a pull PEG.

Methods: In this single center, non-randomized, pilot study, patients unable to undergo a transoral Pull PEG were prospectively recruited for a DPEG during the index endoscopy. IRG procedures performed at our center served as the comparison group. The primary outcome was technical success and secondary outcomes included 30-day and 90-day all-cause mortality, procedure duration, dosage of medications, adverse events, and 30-day all-cause hospitalization. The Charlson comorbidity index was used to compare comorbidities.

Results: A total of 47 patients (68.3 ± 7.13 years) underwent DPEG and 45 patients (68.6 ± 8.23 years) underwent IRG. The respective Charlson comorbidity scores were 6.37 ± 2 and 6.16 ± 1.72 (P = 0.59). Malignancies of the upper aerodigestive tract were the most common indications for DPEG and IRG (42 vs. 37; P = 0.38). The outcomes for DPEG and IRG were as follows: technical success: 96 vs. 98%; P = 1; 30-day all-cause mortality: 0 vs 15%, P < 0.01; 90-day all-cause mortality: 0 vs. 31%, P < 0.001; 30-day hospitalization: 19 vs. 38%; P = 0.06; procedure duration: 23.8 ± 1.39 vs. 29.5 ± 2.03 min, P = 0.02; midazolam dose: 4.5 ± 1.6 vs. 1.23 ± 0.6 mg; P < 0.001, and opiate dose: 105.6 ± 38.2 vs. 70.7 ± 34.5 µg, P < 0.001, respectively. Perforation of the colon during IRG was the sole serious adverse event.

Conclusion: DPEG is a safe and effective alternative to IRG in patients unable to undergo a conventional transoral pull PEG and may be considered as a primary modality for enteral support.

Clinicaltrials: gov Identifier: NCT04151030.

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