Comparative outcomes of endoscopic and radiological gastrostomy tube placement: a systematic review and meta-analysis with GRADE analysis

Divyanshoo R. Kohli, Dhruvil K. Radadiya, Harsh Patel, Prateek Sharma, Madhav Desai

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are invasive interventions used for enteral access. We performed a systematic review and meta-analysis with assessment of certainty of evidence to compare the risk of adverse outcomes and technical failure between PEG and PRG. Methods We queried PubMed, EMBASE, and Cochrane from inception through January 2022 to identify studies comparing outcomes of PEG and PRG. The primary outcome was 30-day all-cause mortality; secondary outcomes included the risk of colon perforation, peritonitis, bleeding, technical failure, peristomal infections, and tube-related complications. We performed GRADE assessment to assess the certainty of evidence and leave-one-out analysis for sensitivity analysis. Results In the final analysis, 33 studies, including 26 high-quality studies, provided data on 275,117 patients undergoing PEG and 192,691 patients undergoing PRG. Data from high quality studies demonstrated that, compared to PRG, PEG had significantly lower odds of selected outcomes, including 30-day all-cause mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.95; P=0.02), colon perforation (OR 0.61, 95%CI 0.49-0.75; P<0.001), and peritonitis (OR 0.71, 95%CI 0.63-0.81; P<0.001). There was no significant difference between PEG and PRG in terms of technical failure, bleeding, peristomal infections or mechanical complications. The certainty of the evidence was rated moderate for colon perforation and low for all other outcomes. Conclusions PEG is associated with a significantly lower risk of 30-day all-cause mortality, colon perforation, and peritonitis compared to PRG, while having a comparable technical failure rate. PEG should be considered as the first-line technique for enteral access.

Original languageEnglish (US)
Pages (from-to)592-602
Number of pages11
JournalAnnals of Gastroenterology
Volume35
Issue number6
DOIs
StatePublished - Nov 19 2022

Bibliographical note

Publisher Copyright:
© 2022 Hellenic Society of Gastroenterology.

Keywords

  • Gastrostomy
  • adverse events
  • meta-analysis
  • peritonitis

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