Gastroenterology and Liver Unit, Royal Hallamshire Hospital, Sheffield, UK.
Eur J Gastroenterol Hepatol. 2010 May;22(5):591-6. doi: 10.1097/MEG.0b013e328332d2dd.
Percutaneous endoscopic gastrostomy (PEG) using the pull through technique is the most widely used insertion method. An alternative is a per-oral image-guided gastrostomy (PIG), which may be advantageous in high-risk patients. As there are no large studies comparing PEG against PIG, we wished to analyse mortality after endoscopic or radiological gastrostomy insertion.
Patients referred for a gastrostomy are prospectively included in a database along with demographic, biochemical and outcome data. Analysis of gastrostomy insertions from February 2004 to 2007 was performed with reference to method of insertion and 30-day outcome. Patients were subgrouped into cognitive impairment, dysphagic stroke, oropharygeal cancer, neurological cancer and other.
One hundred and seventy PIGs and 233 PEGs were inserted (mean age 62 years, 268 males). There were no differences in age between the PIG and the PEG group. The PIG 30-day mortality was 26 of 170 (15.3%) and the PEG 30-day mortality was 25 of 233 (10.7%) (P=0.17). One-year mortality was 92 of 170 (54.1%) for PIG and 131 of 233 (56.7%) for PEG (P=0.60). Subgroup analysis revealed higher 30-day mortality in patients with nasopharyngeal cancer undergoing PIG; 14 of 106 (13.2%) versus one of 69 (1.4%) (P=0.005). However, PIG patients were older than PEG patients (mean age 64 vs. 59.7 years, P=0.019) and had more comorbidities (21.1% in the PEG group and 37.7% in the PIG group).
Overall PIG and PEG seem to have similar 30-day and 1-year mortality rates. Our data suggest that clinicians may opt for either approach depending on technical considerations and local availability.
经皮内镜胃造口术（PEG）采用经皮穿刺技术是最广泛使用的插入方法。另一种方法是经口影像引导胃造口术（PIG），对于高危患者可能具有优势。由于没有比较 PEG 与 PIG 的大型研究，我们希望分析内镜或放射胃造口术后的死亡率。
前瞻性地将接受胃造口术的患者纳入数据库，同时记录人口统计学、生化和结局数据。分析 2004 年 2 月至 2007 年期间的胃造口术插入情况，参考插入方法和 30 天结局。将患者分为认知障碍、吞咽困难性卒中、口咽癌、神经癌和其他。
共插入 170 例 PIG 和 233 例 PEG（平均年龄 62 岁，268 例男性）。PIG 组和 PEG 组的年龄无差异。PIG 组 30 天死亡率为 170 例中的 26 例（15.3%），PEG 组为 233 例中的 25 例（10.7%）（P=0.17）。PIG 组 1 年死亡率为 170 例中的 92 例（54.1%），PEG 组为 233 例中的 131 例（56.7%）（P=0.60）。亚组分析显示，行 PIG 的鼻咽癌患者 30 天死亡率较高：106 例中的 14 例（13.2%）比 69 例中的 1 例（1.4%）（P=0.005）。然而，PIG 组患者比 PEG 组患者年龄更大（平均年龄 64 岁比 59.7 岁，P=0.019），合并症更多（PEG 组为 21.1%，PIG 组为 37.7%）。
总体而言，PIG 和 PEG 的 30 天和 1 年死亡率似乎相似。我们的数据表明，临床医生可能会根据技术考虑因素和当地可用性选择任何一种方法。
