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To Pull or to Scope

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Background:

Percutaneous endoscopic gastrostomy (PEG) tubes are routinely used as an effective method for providing enteral nutrition. The need for their exchange is common.

Goals:

We aimed to examine the comparative safety and cost-effectiveness of PEG percutaneous counter-traction “pulling” approach or by endoscopically guided retrieval.

Study:

A prospective 215 consecutive patients undergoing PEG tube insertion were included. Fifty patients in total were excluded. The patients were examined for demographics, indications for PEG replacement, as well as procedure-related complications and procedural costs.

Results:

Group A included 70 patients (42%) with PEG tubes replaced endoscopically, whereas group B included 95 patients (58%) with PEG tubes replaced percutaneously. Baselines characteristics were similar between the 2 groups (P=NS). Group A and group B had similar immediate complication rates including 4 patients in group B (4.2%), and 2 patients in group A (2.8%) (P=0.24). Complications included a conservatively managed esophageal perforation, and self-limited mild bleeding groups A and group B, respectively. The mean procedure cost was significantly higher in the endoscopic PEG replacement group compared with the percutaneous PEG replacement group ($650 vs. $350, respectively).

Conclusion:

Percutaneous PEG replacement appears as safe as endoscopic PEG replacement, however, percutaneous tube exchange is less costly.
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Keywords: PEG; complications; cost; enteral feeding; replacement route

Document Type: Research Article

Affiliations: 1: Division of Internal Medicine, Institute of Gastroenterology and Liver Diseases 2: Division of Internal Medicine, Institute of Pulmonology, Hebrew University-Hadassah Medical Center, Jerusalem, Israel 3: Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 4: Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, Department Internal Medicine, Division of Gastroenterology, University of South Alabama, Mobile, AL

Publication date: January 1, 2019

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