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

Divyanshoo R. Kohli, Kevin F. Kennedy, Madhav Desai, Prateek Sharma

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1077-1085.e1
JournalGastrointestinal endoscopy
Volume93
Issue number5
DOIs
StatePublished - May 2021
Externally publishedYes

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2021

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