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253 ENDOSCOPIC AND RADIOLOGIC GASTROSTOMY: ANALYSIS OF OUTCOME AND COMPLICATIONS SA Alqahtani, A Rostom, EA Shaffer BACKGROUND: Gastrostomy feeding tube is excellent for providing long-term nutritional support in patients with swallowing difficulties or risk of aspiration.
Division of Gastroenterology, University of Calgary, Calgary, Alberta
PURPOSE: To compare efficacy and safety of percutaneous endoscopic gastrostomy (PEG) versus percutaneous radiologic gastrostomy (PRG).
MATERIAL AND METHOD: A retrospective review of 70 health records evaluated: the indications for the procedure, technical success rate, complications during hospitalization (wound infections, bleeding, perforation, and death), length of hospital stay and death before discharge.
RESULTS: 70 randomly selected patients with gastrostomies had a chart review: n= 30 for PEG and n= 40 for PRG. PEG patients had a mean age of 71±15y; 56% were male. PRG patients had a mean age of 67 ±18y; 63% were male. Major co-morbidities in the study population were: cardiac diseases 37%, pulmonary diseases 30%, hypertension 53%, diabetes 23% and neuromuscular diseases 77%. The mean length of hospitalization was 35±27 days. The indications for gastrostomy feeding were: 74 % for neurological disorders, 18.6% for head and neck cancer; and 7.4% for dysphagia or other reasons. Technical success was similar for PEG and PRG groups (93.3% vs 92.5%, respectively). Early complications occurred in 10% of PEG group vs 12.5% PRG and (p= 0.633). Two patients had GI bleed and required endoscopic intervention. 3 had bowel perforation and another 3 wound bleeding. Wound infection was more frequent in PEG group than PRG group (10% vs 7.5% respectively; p= 0.711). Late complications were more common in PRG group than PEG group (10% vs 0%; p=0.204) including GI bleed in 2 patients, wound bleed in 1 and tube displacement in another. Incidental endoscopic abnormalities, an advantage of the endoscopic method, were identified in 9 patients (30%) of the PEG group. Seven had PUD; 1 had an esophageal ulcer, and another had a hiatus hernia. No procedure-related mortality occurred either group. 10% of the study group died for reasons other than the gastrostomy during the same hospital admission.
CONCLUSION: Percutaneous gastrostomy, whether placed endoscopically or radiologically, is a quite safe and effective method for enteral feeding. The radiologic method of insertion however had a modest increase in complications.