How Safe Is Endoscopic Gastrostomy Tube Placement?
Vanessa M. Shami, MD, FASGE, reviewing Kohli DR, et al. Gastrointest Endosc 2020 Sep 12.
The invasive nature of the endoscopic placement of a gastrostomy tube is associated with higher morbidity and mortality compared to other routine endoscopic procedures. Alternative options to percutaneous endoscopic gastrostomy (PEG) include fluoroscopy-guided gastrostomy (IR-gastrostomy) and surgical gastrostomy. This study utilized the Nationwide Readmissions Database, analyzing data from 2016 and 2017, to compare the safety and outcomes of all 3 techniques in hospitalized patients. Adjusted odds ratios for adverse events were calculated using multivariable logistic regression analysis.
A total of 184,068 patients underwent gastrostomy placement (PEG, 16,384; IR-gastrostomy, 154,007; and surgical gastrostomy, 13,677). Compared with PEG placement, the risk of colon perforation was 1.90 (95% confidence interval [CI], 1.26-2.86) with IR-gastrostomy and 6.65 (95% CI, 4.38-10.12) with surgical gastrostomy. Moreover, the odds of infection were 1.28 (95% CI, 1.07-1.53) for IR-gastrostomy and 1.61 (95% CI, 1.29-2.01) for surgical gastrostomy, and the odds of hemorrhage requiring blood transfusion were 1.84 (95% CI, 1.26-2.68) for IR-gastrostomy versus PEG and 1.09 (95% CI, 0.64-1.86; P=.746) for surgical gastrostomy versus PEG.
The adjusted odds for 30-day readmission compared to PEG placement were 1.13 (95% CI, 1.06-1.2) for surgical gastrostomy and 1.07 (95% CI, 1.03-1.12) for IR-gastrostomy. Finally, using a multivariate analysis, the odds of inpatient mortality were 1.55 (95% CI, 1.42-1.69) for surgical gastrostomy versus PEG and 1.09 (95% CI, 1.02-1.17) for IR-gastrostomy versus PEG.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
Kohli DR, Kennedy KF, Desai M, Sharma P. Safety of endoscopic gastrostomy tube placement compared with radiological or surgical gastrostomy: nationwide inpatient assessment. Gastrointest Endosc 2020 Sep 12. (Epub ahead of print) (https://doi.org/10.1016/j.gie.2020.09.012)