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Comparison of 231 patients receiving either “pull-through” or “push” percutaneous endoscopic gastrostomy

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Abstract

Background

A percutaneous endoscopic gastrostomy (PEG) can be performed as a direct stomach puncture, known as Seldinger technique (“push”) or a thread pulling method (“pull”). The aim of this study was to compare the final results deriving from both application methods.

Methods

Data of all pull-through-PEG and push-PEG applications, which had been carried out in our department from 2009 to 2012, were analyzed and compared retrospectively. Data collection included patients’ demographics, indications, comorbidities, peri-interventional chemotherapy, and/or radiotherapy. The complications were graded according to the Clavien–Dindo classification and divided in early- and late-term complications (before and after 10 days after PEG insertion).

Results

A total of 231 patients received a PEG. Of these, 131 (56.7 %) were treated with pull-through-PEGs and 100 (43.3 %) with the push-PEG method. Overall, in 61 of 231 (26.4 %) patients, a complication was documented and 37 of 61 (60.6 %) were assigned to Clavien–Dindo grade 1. Only 5 of 231 patients (2.2 %) required a re-intervention or surgical treatment under general anesthesia. The overall complication rate was significantly increased by the type of push-PEG tube used (push 33/100 = 33 vs. pull 28/131 = 21.4 %, p = 0.047). A dislocation of the tube was noticed in 5/131 (3.8 %) cases of pull-PEGs and 12/100 (12 %) cases of push PEGs (p = 0.018). An occlusion of the PEG also occurred significantly more frequent in connection with the push-PEG (10/100 = 10 vs. 1/131 = 0.8 %; p < 0.001).

Conclusion

Both PEG techniques are safe and well established. Push PEG showed a significantly higher rate of overall complications, dislocations, and occlusions. The decision which PEG tube should be used depends on individual conditions with preference of push-PEGs in patients with head, neck, and esophageal cancer.

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Acknowledgments

The authors wish to thank to our Stoma nurses Martina Steinbeiß and Adelheid Anzinger for supplying their records, Babette Dörr for data and quality management, and Norbert Denkmayr and his team of the institute of hygiene for providing supplementary information to our study data. The kind statistical support by Mag. Anita Ferihumer and Univ. Prof. Dr. Helmut Beran is greatly acknowledged.

Disclosures

Gernot Koehler, Veronika Kalcher, Oliver Owen Koch, Ruzica-Rosalia Luketina, Klaus Emmanuel, and Georg Spaun have no conflict of interests or financial ties to disclose. All authors do disclose all institutional or corporate/commercial relationships to all the time of the data collection going back 5 years and longer.

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Authors and Affiliations

  1. Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria

    Gernot Köhler, Veronika Kalcher, Oliver O. Koch, Ruzica-R. Luketina, Klaus Emmanuel & Georg Spaun

  2. Academic Teaching Hospital of the Medical University, Graz, Austria

    Gernot Köhler, Veronika Kalcher, Oliver O. Koch, Ruzica-R. Luketina, Klaus Emmanuel & Georg Spaun

  3. Academic Teaching Hospital of the Innsbruck Medical University, Innsbruck, Austria

    Gernot Köhler, Veronika Kalcher, Oliver O. Koch, Ruzica-R. Luketina, Klaus Emmanuel & Georg Spaun

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  1. Gernot Köhler
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  2. Veronika Kalcher
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Correspondence to Gernot Köhler.

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Köhler, G., Kalcher, V., Koch, O.O. et al. Comparison of 231 patients receiving either “pull-through” or “push” percutaneous endoscopic gastrostomy. Surg Endosc 29, 170–175 (2015). https://doi.org/10.1007/s00464-014-3673-9

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  • DOI: https://doi.org/10.1007/s00464-014-3673-9

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