Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 031811, South Korea.
Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
Surg Endosc. 2019 Mar;33(3):750-756. doi: 10.1007/s00464-018-6339-1. Epub 2018 Aug 21.
Gastrostomy tube insertion is beneficial to selected patients, and percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are two of the frequently used methods in gastrostomy. This study aimed to investigate the indications and complications of both PEG and PRG.
This was a retrospective multicenter cohort study. Patients who underwent initial PEG or PRG tube insertion for nutritional purpose between January 2010 and December 2015 at five university hospitals were included in the study. We analyzed the indications and all complications related to gastrostomy, which were divided into the major (systemic or life-threatening) and minor (local and non-life-threatening) categories.
A total of 418 patients who underwent PEG (n = 324) and PRG (n = 94) were reviewed. The indications for gastrostomy tube insertion were different and included mainly neurological disease (n = 240, 74.1%) such as cerebrovascular accident in the PEG group (n = 119, 36.7%) and mainly surgical disease (n = 28, 29.8%) such as head and neck cancer (n = 16, 17.0%) in the PRG group (p = 0.05). There were no differences in the minor (16.4% vs. 19.1%, p = 0.52) and major (12.3% vs. 14.9%, p = 0.51) complication rates between the PEG and PRG groups. The risk factors for complications were age [yearly increments; odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01-1.06], tube diameter (1-Fr increments; OR 1.26, 95% CI 1.01-1.58), insertion time (1-min increments; OR 1.07, 95% CI 1.01-1.13), and neurological disease as the gastrostomy indication (vs. surgical disease; OR 4.61 95% CI 1.47-14.42).
In our study, both PEG and PRG provided a safe route for nutrition delivery despite their different indications. Our data suggest that PEG might be the procedure of choice for patients with medical or neurological disease and PRG for patients with surgical disease in whom PEG is technically difficult or contraindicated.
胃造口管插入术对选定的患者有益，经皮内镜胃造口术（PEG）和经皮放射学胃造口术（PRG）是胃造口术常用的两种方法。本研究旨在探讨 PEG 和 PRG 的适应证和并发症。
这是一项回顾性多中心队列研究。纳入 2010 年 1 月至 2015 年 12 月期间在五所大学医院因营养目的首次行 PEG 或 PRG 管插入的患者。我们分析了与胃造口术相关的适应证和所有并发症，分为主要（全身性或危及生命）和次要（局部和非危及生命）两类。
共回顾了 418 例接受 PEG（n=324）和 PRG（n=94）的患者。胃造口管插入的适应证不同，主要包括神经疾病（n=240，74.1%），如 PEG 组的脑血管意外（n=119，36.7%）和主要包括手术疾病（n=28，29.8%），如 PRG 组的头颈部癌症（n=16，17.0%）（p=0.05）。PEG 和 PRG 组的次要（16.4%比 19.1%，p=0.52）和主要（12.3%比 14.9%，p=0.51）并发症发生率无差异。并发症的危险因素包括年龄[每年递增；优势比（OR）1.03，95%置信区间（CI）1.01-1.06]、管直径（1Fr 递增；OR 1.26，95%CI 1.01-1.58）、插入时间（1 分钟递增；OR 1.07，95%CI 1.01-1.13）和胃造口术适应证为神经疾病（与手术疾病相比；OR 4.61，95%CI 1.47-14.42）。
在我们的研究中，尽管适应证不同，PEG 和 PRG 都为营养输送提供了安全的途径。我们的数据表明，PEG 可能是患有内科或神经疾病患者的首选方法，而 PRG 可能是患有外科疾病且 PEG 技术上困难或禁忌的患者的首选方法。
