Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single-center study.

Background and Aims: Percutaneous endoscopic gastrostomy (PEG) is indicated for prolonged enteral nutrition. This study aimed to analyze the outcome and to identify potential risk factors for complications in PEG procedures.

Methods: A single-center retrospective analysis of the performed PEG procedures during the period January 2010 till January 2020.

Results: A PEG placement procedure was performed in 854 patients (64.1% male) and was successful in 833 (97.5%). In total, 513 push (61.6%) and 320 pull (38.6%) PEGs were placed. The mean age was 60.7 years, and the median follow-up was 267 days. The push PEG was associated with peri-procedural bleeding ( P  = 0.002) and tube dislodgements ( P  < 0.001), while the pull PEG was significantly associated with buried bumpers ( P  < 0.001), infected placement sites ( P  = 0.019), and granulation tissue formation ( P  = 0.044). The PEG-related mortality rate was 0.2%, but the overall 30-day mortality was 4.0%.

Conclusion: The current study showed that the push and pull PEG placements are both safe and feasible procedures, with a low PEG-related mortality. Buried bumpers, infected placement sites, and granulation tissue formation are more often seen in the pull PEG, while the push PEG is associated with periprocedural bleeding and tube dislodgements. These complications should be taken into account and there is a need for a prospective trial to identify superiority between the PEG methods.