Gastroenterology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, UAE
Gastroenterology, Seoul National University Hospital, Jongno-gu, the Republic of Korea.
BMJ Open Gastroenterol. 2022 Apr;9(1). doi: 10.1136/bmjgast-2022-000881.
Percutaneous gastrostomy (PG) is a common procedure that enables long-term enteral nutrition. However, data on the durability of individual tube types are insufficient. We conducted this study to compare the longevities and features of different PG tube types.
We performed a 5-year retrospective analysis of patients who underwent endoscopic and radiologic PG-related feeding tube procedures. The primary and secondary outcomes were tube exchange intervals and revenue costs, respectively. Demographic factors, underlying diseases, operator expertise, materials used, and complication profiles were assessed.
A total of 599 PG-related procedures for inserting pull-type PG (PGP), balloon-type PG (PGB), PG jejunal MIC* (PGJM; gastrojejunostomy type), and PG jejunal Levin (PGJL) tubes were assessed. On univariate Kaplan-Meier analysis, PGP tubes showed longer median exchange intervals than PGB tubes (405 days (95% CI: 315 to 537) vs 210 days (95% CI: 188 to 238); p<0.001). Larger PGB tubes diameters were associated with longer durations than smaller counterparts (24 Fr: 262 days (95% CI: 201 to NA), 20 Fr: 216 days (95% CI: 189 to 239), and 18 Fr: 148 days (95% CI: 100 to 245)). The PGJL tubes lasted longer than PGJM counterparts (median durations: 168 days (95% CI: 72 to 372) vs 13 days (95% CI: 23 to 65); p<0.001). Multivariate Cox proportional regression analysis revealed that PGJL tubes had significantly lower failure rates than PGJM tubes (OR 2.97 (95% CI: 1.17 to 7.53); p=0.022). PGB tube insertion by general practitioners was the least costly, while PGP tube insertion by endoscopists was 2.9-fold more expensive; endoscopic PGJM tubes were the most expensive at two times the cost of PGJL tubes.
PGP tubes require replacement less often than PGB tubes, but the latter are more cost-effective. Moreover, PGJL tubes last longer than PGJM counterparts and, owing to lower failure rates, may be more suitable for high-risk patients.
经皮胃造口术（PG）是一种常见的长期肠内营养方法。然而，关于不同管型的耐用性的数据不足。我们进行这项研究是为了比较不同 PG 管型的长期使用效果和特点。
我们对接受内镜和放射学 PG 相关喂养管程序的患者进行了 5 年回顾性分析。主要和次要结果分别为管更换间隔和收入成本。评估了人口统计学因素、基础疾病、操作者经验、使用的材料和并发症情况。
共评估了 599 例经皮胃造口术（PGP）、球囊型 PG（PGB）、PG 空肠 MIC*（PGJM；胃空肠吻合术型）和 PG 空肠 Levin（PGJL）管的相关程序。在单变量 Kaplan-Meier 分析中，PGP 管的中位更换间隔长于 PGB 管（405 天（95%CI：315 至 537）与 210 天（95%CI：188 至 238）；p<0.001）。较大的 PGB 管直径与较长的持续时间相关，而较小的 PGB 管直径则相反（24 Fr：262 天（95%CI：201 至 NA）、20 Fr：216 天（95%CI：189 至 239）和 18 Fr：148 天（95%CI：100 至 245））。PGJL 管的持续时间长于 PGJM 管（中位持续时间：168 天（95%CI：72 至 372）与 13 天（95%CI：23 至 65）；p<0.001）。多变量 Cox 比例风险回归分析显示，PGJL 管的失败率明显低于 PGJM 管（OR 2.97（95%CI：1.17 至 7.53）；p=0.022）。全科医生进行 PGB 管插入的成本最低，而内镜医生进行 PGP 管插入的成本则高 2.9 倍；内镜 PGJM 管的成本是 PGJL 管的两倍。
PGP 管的更换频率低于 PGB 管，但后者更具成本效益。此外，PGJL 管的持续时间长于 PGJM 管，由于失败率较低，可能更适合高风险患者。
