Safety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment

doi:10.1016/j.gie.2020.09.012

Gastrointestinal Endoscopy

Volume 93, Issue 5, May 2021, Pages 1077-1085.e1

https://doi.org/10.1016/j.gie.2020.09.012 Get rights and content

Background and Aims

A gastrostomy tube is often required for inpatients requiring long-term nutritional access. We compared the safety and outcomes of 3 techniques for performing a gastrostomy: percutaneous endoscopic gastrostomy (PEG), fluoroscopy-guided gastrostomy by an interventional radiologist (IR-gastrostomy), and open gastrostomy performed by a surgeon (surgical gastrostomy).

Methods

Using the Nationwide Readmissions Database, we identified hospitalized patients who underwent a gastrostomy from 2016 to 2017. They were identified using the International Classification of Diseases, 10th Revision, Procedure Coding System. The selected patients were divided into 3 cohorts: PEG (0DH64UZ), IR-gastrostomy (0DH63UZ), and open surgical gastrostomy (0DH60UZ). Adjusted odds ratios for adverse events associated with each technique were calculated using multivariable logistic regression analysis.

Results

Of the 184,068 patients meeting the selection criteria, the route of gastrostomy tube placement was as follows: PEG, 16,384 (53.7 ± 29.0 years); IR-gastrostomy, 154,007 (67.2 ± 17.5 years); and surgical gastrostomy, 13,677 (57.9 ± 24.3 years). Compared with PEG, the odds for colon perforation using IR-gastrostomy and surgical gastrostomy, respectively, were 1.90 (95% confidence interval [CI], 1.26-2.86; P = .002) and 6.65 (95% CI, 4.38-10.12; P < .001), for infection of the gastrostomy 1.28 (95% CI, 1.07-1.53; P = .006) and 1.61 (95% CI, 1.29-2.01; P < .001), for hemorrhage requiring blood transfusion 1.84 (95% CI, 1.26-2.68; P = .002) and 1.09 (95% CI, .64-1.86; P = .746), for nonelective 30-day readmission 1.07 (95% CI, 1.03-1.12; P = .0023) and 1.13 (95% CI, 1.06-1.2; P = .0002), and for inpatient mortality 1.09 (95% CI, 1.02-1.17; P = .0114) and 1.55 (95% CI, 1.42-1.69; P < .0001).

Conclusions

Placement of a gastrostomy tube (PEG) endoscopically is associated with a significantly lower risk of inpatient adverse events, mortality, and readmission rates compared with IR-gastrostomy and open surgical gastrostomy.

Graphical abstract

Section snippets

Study design

This is a retrospective analysis of hospitalized patients who underwent a gastrostomy. Patients were identified using the International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) with a nationally representative database of hospitalized patients.

Description of the database

The Nationwide Readmissions Database was developed through a federal, state, and industry partnership sponsored by the Agency for Healthcare Research and Quality for the Healthcare Cost and Utilization Project.¹⁶ It

Results

A total of 184,068 patients (aged 65.3 ± 19.8 years; 44.3% women) met the selection criteria and included 16,384 patients who underwent a PEG (aged 53.7 ± 29.0 years, 46% women), 154,007 patients who underwent an IR-gastrostomy (aged 67.2 ± 17.5 years, 44% women), and 13,677 patients who underwent a surgical gastrostomy (aged 57.9 ± 24.3 years, 46.3% women). Demographics are shown in Table 1 and comorbidities in Supplementary Table 1 (available online at www.giejournal.org).

Discussion

Gastrostomy creation is the most common intervention for long-term enteral access to facilitate a bolus feeding regimen.⁹ A gastrostomy can also be used for multiple reasons other than nutrition, including retrograde intestinal access to the biliary system for facilitation of ERCP in surgically altered anatomy or other procedures.⁹^,²⁰ Gastrostomy has evolved from an open surgical technique with high mortality to varying methodologies including endoscopic, fluoroscopic, and laparoscopic or open

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Citation Excerpt :
Perforation of the transverse colon is another major potential AE. This was reported in .2% in the large inpatient cohort and in .12% in a nationwide cohort.120,121 There was a higher risk for interventional radiology–guided PEG placement versus endoscopic PEG (OR, 1.90; 95% CI, 1.26-2.86).120

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: DISCLOSURE: The following authors disclosed financial relationships: D. R. Kohli: Research support from Olympus. P. Sharma: Consultant for Lumendi, Olympus, Boston Scientific, Bausch, Medtronic USA, and Fujifilm; research support from Olympus, Medtronic USA, Fujifilm, U.S. Endoscopy, Ironwood, Erbe, Docbot, Cosmo Pharmaceuticals, and CDx Labs; equipment loan from Medtronic Italy. All other authors disclosed no financial relationships.

: If you would like to chat with an author of this article, you may contact Dr Kohli at [email protected] or [email protected].

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Original articleClinical endoscopySafety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment

Background and Aims

Methods

Results

Conclusions

Graphical abstract

Section snippets

Study design

Description of the database

Results

Discussion

Gastrointest Endosc

Gastroenterology

Clinics (Sao Paulo)

Nutrition

Gastrointest Endosc Clin North Am

Gastrointest Endosc

Gastrointest Endosc

Eur J Radiol

J Vasc Interv Radiol

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Nutrition

ACG clinical guideline: nutrition therapy in the adult hospitalized patient

Am J Gastroenterol

Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances

Cochrane Database Syst Rev

CIRSE standards of practice guidelines on gastrostomy

Cardiovasc Intervent Radiol

Gastrostomy tube placement outcomes: comparison of surgical, endoscopic, and laparoscopic methods

Nutr Clin Pract

Complications of percutaneous endoscopic and radiologic gastrostomy tube insertion: a KASID (Korean Association for the Study of Intestinal Diseases) study

Surg Endosc

Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis

Clin Otolaryngol

Percutaneous endoscopic gastrostomy complication rates and compliance with the American Society for Gastrointestinal Endoscopy guidelines for the management of antithrombotic therapy

JPEN J Parenter Enteral Nutr

Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta-analysis of the literature

Radiology

Original article
Clinical endoscopy
Safety of endoscopic gastrostomy tube placement compared with radiologic or surgical gastrostomy: nationwide inpatient assessment