Background Two different techniques for percutaneous endoscopic gastrostomy (PEG) are established: the classical pull-through technique (PTT) and the direct punction technique (DPT). The comparison of the safety of both methods has shown contradicting results in five small studies with a total of 408 patients. The current ESGE guideline recommends the use of PTT despite low evidence. This study compares the complication rate of both techniques in a large retrospective patient cohort.
Patients and methods Clinical data from patients receiving a PEG in four high volume centers were collected retrospectively between January 2016 and December 2018. Patient characteristic and complication rate were correlated in uni- and multivariate analyses.
Results Data from 1014 patients with PTT and 183 patients with DPT were analyzed. DPT resulted in a 50.0 % reduction of minor complication rates and an 85.7 % reduction of major complications. In particular, the postinterventional appearance of wound infections, peritonitis, pneumoperitoneum und bleeding complication was significantly reduced in the DPT group. The multivariate analysis indicates a odds ratio of 0.067 (0.02 - 0.226; p< 0.001) for major complications in the DPT group.
Conclusion Our data from a retrospective, multicenter cohort indicate that DPT results in a significant reduction of the complication rate. Despite the retrospective design of this study, these results should lead to a change in practice in order to improve patient safety.
