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. 2022 Nov-Dec;35(6):592-602.
doi: 10.20524/aog.2022.0752. Epub 2022 Oct 17.

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

Divyanshoo R Kohli  1   2 , Dhruvil K Radadiya  1 , Harsh Patel  3 , Prateek Sharma  1 , Madhav Desai  1
Affiliations

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

Divyanshoo R Kohli et al. Ann Gastroenterol. 2022 Nov-Dec.

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.

Keywords: Gastrostomy; adverse events; meta-analysis; peritonitis.

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Conflict of interest statement

Conflict of Interest: 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

Figures

Figure 1
Figure 1
PRISMA diagram PEG, percutaneous endoscopic gastrostomy; PEG-J, percutaneous endoscopic transgastric jejunostomy; PIG, per-oral image-guided gastrostomy
Figure 2
Figure 2
Forest plots and funnel plots for 30-day all-cause mortality, colon perforation, and peritonitis
Figure 3
Figure 3
Forest plot for all outcomes PEG, percutaneous endoscopic gastrostomy; PRG percutaneous radiological gastrostomy
See this image and copyright information in PMC

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