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Abstract
Objective
To compare indications, success rates and complications of pull [P] and introducer [I] techniques for percutaneous endoscopic gastrostomy (PEG).
Methods
In this retrospective study, inpatients who underwent primary PEG tube insertion between January 2015 and February 2020 at the Endoscopy Center of the First Affiliated Hospital of Fujian Medical University were included.
Results
A total of 103 inpatients were included in this study (P group, n = 67; I group, n = 36). The rates of tube replacement within first six months in the P and I groups were 1.5% and 11.1%, respectively (P = 0.049). The most common primary indication of PEG was malignancy. The proportion of patients with esophageal cancer was significantly lower in the P group (24.4% vs 54.2%, P = 0.015). No significant difference was found in the overall, major, or minor complications between the two groups. In patients with esophageal stenosis, the pull method was a risk factor for complications (P = 0.03; odds ratio [OR] = 12, 95% confidence interval [CI]: 1.164–123.684). Logistic regression analysis showed that the risk factors for major and minor complications were the admission-to-gastrostomy interval (OR = 1.078, 95% CI: 1.016–1.145, P = 0.014) and lack of antibiotic use (OR = 4.735, 95% CI: 1.247–17.979, P = 0.022), respectively.
Conclusion
Both PEG techniques have high clinical success rates. The introducer technique is more suitable for patients with esophageal stricture, which has lower minor complications, but higher rate of tube replacement compared to the pull technique. Use of antibiotics may reduce minor complications following PEG. Early PEG insertion may help to reduce post-PEG major complications.
Ethics Approval and Informed Consent
The comments of Ethics Committee of First Affiliated of Fujian Medical University are as follows: On Apr. 3rd, 2019, According to the national ethical principles of Good Clinical Practice, Declaration of Helsinki and Measures for the Ethical Review of Biomedical Research Involving Humans: a meeting ethical review of the project was conducted, and the project is approved to be carried out in our hospital.
The Institutional Review Board (IRB) declares that: In accordance with the requirements of ICH-GCP, China GCP and relevant laws and regulations or guidelines in China, the review and other working processes are free from any influence of any organization or individuals other than this Ethics Committee.
The Ethics Committee of First Affiliated of Fujian Medical University waived the need for patient consent to review their medical records as the confidentiality of patient data was maintained.
Acknowledgments
The authors report no grants or financial support for this work.
Author Contributions
Xia Li designed the study, extracted and analyzed data, interpreted results and wrote and substantially revised the manuscript. Ze-Hao Zhuang designed the study, substantially revised and critically reviewed the article. Jun-Xi Wang and Jing-Jing Wei made a significant contribution to acquisition of data and analysis, and took part in drafting and reviewing the article. Yu-Ping Wang, Jia-Xin Shen, Yi-Xing Zheng and Pei-Hong Zhang made a contribution to acquisition of data and analysis, and took part in drafting the manuscript. And all authors gave final approval of the version to be published, have agreed on the journal to which the article has been submitted and agree to be accountable for all aspects of the work.
Disclosure
Dr Ze-Hao Zhuang reports a patent “An internal fixed gastroenterostomy replacement device with memory” issued. The authors report no other conflicts of interest in this work.