Outcomes of radiologically inserted gastrostomy versus percutaneous endoscopic gastrostomy.

Gastrostomy insertion either via radiological (radiologically inserted gastrostomy, RIG) or endoscopic (percutaneous endoscopic gastrostomy, PEG) approaches are widely practiced throughout Australia. The purpose of this study was to compare outcomes of inserted tubes and cost evaluation by both methods. A retrospective cohort study conducted on all-cause gastrostomy insertions at a quaternary Australian Hospital, Royal Brisbane and Womens' Hospital (RBWH) between January 2012 and August 2015. Current referral pattern is first-line gastrostomy and second-line radiological insertion. A total of 402 gastrostomy tubes were inserted with a total of 307 PEG tubes and 95 RIG tubes, with follow-up to one calendar year. Mean patient age was 61 years ± 14.2 years with 76% male patients. A total of 84% of patients were head and neck cancer patients; major indications for insertion include prophylaxis (58%), dysphagia (32%) and NBM (2.5%). Patient groups were heterogeneous with varied indications for insertion including prophylaxis, dysphagia, decompression, NBM and treatment side effects. Outcomes measured included the following: complications, premature tube failure prior to expected removal and, overall tube outcome/ disposition. A lower incidence of minor complications was observed with the RIG group than the PEG group without differences in major complications over time. Tube failure due to either blockage or dislodgement was assessed. Multivariate analysis of all-cause dislodgement found 'method of insertion' a predictor of dislodgement with RIG 5.4(OR) times more likely to be dislodged than PEG. Competing risk analysis demonstrates equipment as a significant cause of dislodgement occurring more commonly with RIG than PEG tubes. Tubes were removed more often in the PEG group because a large volume were prophylactic. Tubes were replaced more often in the RIG group, with tube blockage and equipment as causes for tube replacement in this group. Replacements occur either in suite or bedside. Costing data were limited with only 94 patients' costing data qualifying for a limited unit cost evaluation, with radiologically inserted tubes marginally more expensive than tubes inserted endoscopically. Both are safe procedures, with improved techniques; radiologically inserted gastrostomies have an improved profile with respect to dislodgement rates than previously reported in the literature. Radiological tubes remain limited by equipment factors with balloon failure an ongoing issue. Cost analysis was hindered by poor documentation; however, the opportunity cost remains an important advantage of radiological insertion at peripheral sites, increasingly relevant for health service delivery in our geographically vast state.

Cherian P ，Blake C ，Appleyard M ，Clouston J ，Mott N ... -  《-》

Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): A comparison of outcomes at an Australian teaching hospital.

Gastrostomy tubes for enteral nutrition are most commonly inserted via percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) techniques. The current study aimed to compare clinical outcomes and complication rates in patients who underwent PEG and RIG procedures at a tertiary teaching hospital in Australia. A retrospective review was conducted on patients who underwent PEG or RIG tube insertion between February 2013 and February 2015 at Flinders Medical Centre, Australia. The primary outcome studied was the tube dislodgement rate. Secondary outcomes measured included hospital length of stay, 30 day and 1 year mortality and peri- and post-procedural complications such as hypoxia, bleeding, stoma site infection and haematoma. Baseline comparisons were conducted using the Mann-Whitney test and chi square test. 137 patients (PEG = 85, RIG = 52) underwent gastrostomy tube insertion. Indications for insertion were head and neck cancer (PEG = 30, RIG = 21), stroke (PEG = 27, RIG = 11), post-trauma (PEG = 6, RIG = 3) and neuromuscular pathologies (PEG = 9, RIG = 0). There was a significantly higher tube dislodgement rate in RIG (26.5%) compared to PEG (2.4%), p < 0.001. The 1-year mortality was also significantly higher after RIG (46.2%) compared to the PEG group (16.7%), p < 0.05. No differences were seen in other peri- and post-procedural complications. Although both PEG and RIG insertion techniques compare favourably in terms of the majority of peri and post procedural complications, the rates of tube dislodgement were significantly higher in the RIG group. The higher mortality rate at 1 year after RIG placement may be related to patient selection particularly as no differences were seen at 30 days.

Vidhya C ，Phoebe D ，Dhina C ，Jayne S ，Robert F ... -  《Clinical Nutrition ESPEN》

Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates.

Patients with head and neck cancer who have resection, radiotherapy, chemoradiotherapy, or a combination of these require nutritional support to be implemented before treatment, and this may involve insertion of a prophylactic gastrostomy feeding tube. The aim of this study was to compare the use and complication rates of percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) in these patients at a tertiary referral centre. We retrospectively reviewed gastrostomy data forms completed by nutritional support nursing staff over a recent 34-month period, which included information on method of insertion, 30-day postoperative serious and minor complications, and mortality. A total of 110 patients had prophylactic insertion of a gastrostomy (21 PEG, 89 RIG) over the study period. In the first 12 months 13 (31%) PEG feeding tubes were placed but in the last 12 months none were inserted using an endoscopic approach. Serious complications occurred with 2 (10%) PEG and 12 (13%) RIG; the most common cause was accidental removal of the tube (n=13, 12%). Minor complications of peristomal infection, leakage, or blockage of the tube occurred in 6 (5%) gastrostomies. No patients died during the study period. In recent years, and in the absence of recommended guidelines, there has been an increase in the elective insertion of RIG in patients with head and neck cancer. Serious complications for both methods of insertion in this study are comparable with similar reports. However, with RIG there is a high rate of tubes becoming dislodged with the potential for serious consequences. The most appropriate method to insert a gastrostomy tube in patients with head and neck cancer remains unclear.

McAllister P ，MacIver C ，Wales C ，McMahon J ，Devine JC ，McHattie G ，Makubate B ... -  《-》

Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients.

Rustom IK ，Jebreel A ，Tayyab M ，England RJ ，Stafford ND ... -  《JOURNAL OF LARYNGOLOGY AND OTOLOGY》

Gastrostomy tube placement by radiological versus endoscopic methods in an acute care setting: a retrospective review of frequency, indications, complications and outcomes.

Galaski A ，Peng WW ，Ellis M ，Darling P ，Common A ，Tucker E ... -  《-》