Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy

Figures & data

Figure 1 Patient flow diagram with inclusion and exclusion data.

Figure 2 The procedure of percutaneous endoscopic gastrostomy (PEG) insertion by the introducer method. (A) Fixing the stomach and abdominal wall with a gastropexy device. (B) Insertion of the special trocar. (C) Insertion of a balloon feeding tube. (D) Internal fixation was completed by water injection.

Table 1 Patient Characteristics

	Pull-PEG (n = 67)	Introducer-PEG (n = 36)	P-value
Age (y, mean ± SD)	62.10 ± 12.3	62.83 ± 13.5	0.782
Male [(n, %)]	51 (76.1)	29 (80.6)	0.606
Admission-to PEG interval [days, mean (25–75%)]	6 (2–15)	6.5 (2.25–11.5)	0.703
Use of antibiotics [n (%)]	25 (37.3)	7 (19.4)	0.062
ASA classification [n (%)]
I	0	0	0.839
II	18 (26.9)	10 (27.8)
III	36 (53.7)	20 (55.6)
IV	13 (19.4)	5 (13.9)
V	0	1 (2.8)
VI	0	0
Main biochemical indicators (mean ± SD)
Hb (g/L)	108 ± 16	112 ± 22	0.344
PLT (10^9/L)	333 ± 126	284 ± 120	0.084
INR	1.10 ± 0.12	1.11 ± 0.11	0.794
ALB (g/L)	35.8 ± 4.5	35.8 ± 5.2	0.997

Abbreviations: ALB, albumin; ASA, American Society of Anesthesiologists; Hb, hemoglobin; INR, international normalized ratio; PEG, percutaneous endoscopic gastrostomy; PLT, platelet; SD, standard deviation.

Table 2 Indications for Percutaneous Endoscopic Gastrostomy (PEG) [n (%)]

Indications	Pull-PEG (n = 67)	Introducer-PEG (n = 36)
Neurological disorder*	16 (24)	9 (25)
Cerebrovascular accident	7 (10)	7 (19)
Brain trauma	5 (7)	0
Parkinson’s disease	1 (2)	0
Motor neuron disease	1 (2)	1 (3)
Dementia	0	0
Others^a	2 (3)	1 (3)
Tumors**	41 (61)	24 (67)
Head/neck	28 (42)	11 (31)
Esophagus	10 (15)	13 (36)
Stomach	1 (1)	0
Pancreas	1 (1)	0
Duodenum	1 (1)	0
Others^b	10 (15)	3 (8)

Notes: P=0.718. *P = 0.267; **P = 0.036. ^aOthers: Dysphagia (due to radiation encephalopathy; n = 1), multiple cranial neuritis (n = 1), progressive supranuclear ophthalmoplegia (n = 1). ^bOthers: Posterior mediastinal sarcomatoid carcinoma after chemotherapy (n = 1), nausea and vomiting of unknown etiology (n = 1), pneumonia (n = 1), functional dysphagia (n = 1), unexplained dysphagia (n = 1), right vocal cord paralysis (n = 1), post-intracranial aneurysm surgery (n = 2), traumatic contusions (gastrointestinal, mesenteric [omental] contusion and laceration; n = 1), removal of esophageal foreign body (n = 1), postoperative drainage of neck and mediastinal abscess caused by esophageal rupture (n = 1), thoracic aortic aneurysm-esophageal fistula (n = 1), unexplained malnutrition (n = 2).

Table 3 Comparison of Complications Between the Two Groups [n (%)]

Complications	Pull-PEG (n = 67)	Introducer-PEG (n = 36)	P-value
Overall complications	1 (1)	3 (8)	0.122
Major complications	4 (6)	2 (6)	1.000
Bleeding from the puncture site	3 (4)	1 (3)	1.000
Aspiration pneumonia	2 (3)	3 (8)	0.340
Minor complications	19 (28)	6 (17)	0.187
Tube dislodgement	0	2 (6)	0.120
Abscess, wound infection	3 (4)	0	0.550
Diarrhea	2 (3)	0	0.541
Tube blockage	1 (1)	0	1.000
Pain	18 (27)	8 (22)	0.605
Intraoperative complications	0	0	-
Post-procedural complications	24 (36)	11 (31)	0.591
Therapy			0.575
Medical treatment	14 (21)	5 (14)
Surgical treatment	2 (3)	1 (3)
Hospital stay [days, mean (25–75%)]	13.5 (9–27.3)	12 (7.5–20)	0.536

Abbreviation: PEG, percutaneous endoscopic gastrostomy.

Table 4 Multivariate Analysis of the Factors Affecting Complications

Influencing Factors	Overall Complications	Major Complications	Minor Complications
	OR (95% CI)	OR (95% CI)	OR (95% CI)
ASA classification	1.476 (0.317–6.879)	2.268 (0.636–8.093)	0.959 (0.464–1.980)
Admission-to-gastrostomy interval (d)	0.890 (0.694–1.142)	1.078 (1.016–1.145)*	1.044 (0.992–1.098)
Lack of antibiotics	0.895 (0.073–11.009)	1.154 (0.163–8.164)	4.735 (1.247–17.979)**
Pull-PEG (versus Introducer-PEG)	0.192 (0.018–2.102)	1.173 (0.162–8.513)	2.303 (0.778–6.817)

Notes: *P = 0.014; **P = 0.022; the rest P > 0.05.

Abbreviations: ASA, American Society of Anesthesiologists; CI, confidence interval; OR, odds ratio; PEG, percutaneous endoscopic gastrostomy.