E0279 - Outcomes and Complications of Radiologic Gastrostomy vs Percutaneous Endoscopic Gastrostomy for Enteral Feeding - An Updated Systematic Review and Meta-Analysis

Award: Presidential Poster Award

Zohaib Ahmed, MD¹, Umair Iqbal, MD², Muhammad Aziz, MD³, Syeda F. Arif, ⁴, Joyce Badal, PharmD⁵, Umer Farooq, MD⁶, Wade M. Lee-Smith, MLS⁴, Faisal Kamal, MD⁷, Asif Mahmood, MD⁴, Ali Nawras, MD⁴, Bradley D. Confer, DO², Douglas G. Adler, MD, FACG^8
1University of Toledo, Maumee, OH; ²Geisinger Medical Center, Danville, PA; ³The University of Toledo Medical Center, Toledo, OH; ⁴University of Toledo, Toledo, OH; ⁵University of Toledo College of Medicine, Toledo, OH; ⁶Loyola Medicine/MacNeal Hospital, Berwyn, IL; ⁷University of California, San Francisco, San Francisco, CA; ⁸Centura Health-Porter Adventist Hospital, Salt Lake City, UT

Introduction: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are commonly utilized to establish access to enteral nutrition. However, data comparing the outcomes of PEG vs. PRG are conflicting. Our aim was to conduct an updated systemic review and meta-analysis comparing PRG and PEG outcomes.

Methods: A systematic review was conducted using Medline, Embase, and Cochrane library databases until December 21, 2021. Primary outcomes included 30-day mortality, tube leakage, tube dislodgement, perforation, and peritonitis. Secondary outcomes included bleeding, infectious complications, and aspiration pneumonia. All analyses were conducted using comprehensive meta-analysis software.

Results: The initial search revealed 819 studies. Of these, 41 of these studies met our inclusion criteria and were included in the final meta-analysis. Of 471,091 total patients, 194,350 received PRG and 276,741 received PEG. PRG was associated with higher odds of 30-day mortality when compared to PEG (OR: 1.220, 95% CI: 1.162-1.282, I2=54.2%). In addition, tube leakage and tube dislodgement were higher in the PRG group than in PEG (OR: 2.231, 95% CI:1.184-4.2 and OR: 2.612, 95% CI: 1.917-3.56 respectively). Perforation, peritonitis, bleeding, and infectious complications were also higher with PRG than PEG, although this was not statistically significant on sensitivity analysis. There was no significant difference in the risk of aspiration pneumonia.

Discussion: This systematic review and meta-analysis comparing PRG, and PEG outcomes found higher odds of 30-day mortality, tube leakage, and tube dislodgement with PRG compared to PEG. Rates of bleeding, perforation, infectious complications, and peritonitis were significantly higher with PRG than with PEG, but these results did not achieve statistical significance in a sensitivity analysis.

Our meta-analysis has the following strengths: systematic literature search with well-defined inclusion criteria, the inclusion of all available studies in the current literature, careful exclusion of redundant studies, high-quality studies with detailed data extraction, and rigorous study quality evaluation. Our pooled rates are calculated from 471,091 patients, a very robust figure.

In summary, PRG is associated with higher 30-day mortality and gastrostomy tube-related complications than PEG. Additional studies, particularly large RCTs, are warranted.



Disclosures:


Zohaib Ahmed, MD¹, Umair Iqbal, MD², Muhammad Aziz, MD³, Syeda F. Arif, ⁴, Joyce Badal, PharmD⁵, Umer Farooq, MD⁶, Wade M. Lee-Smith, MLS⁴, Faisal Kamal, MD⁷, Asif Mahmood, MD⁴, Ali Nawras, MD⁴, Bradley D. Confer, DO², Douglas G. Adler, MD, FACG⁸. E0279 - Outcomes and Complications of Radiologic Gastrostomy vs Percutaneous Endoscopic Gastrostomy for Enteral Feeding - An Updated Systematic Review and Meta-Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.