Kohli Divyanshoo R, Radadiya Dhruvil K, Patel Harsh, Sharma Prateek, Desai Madhav
Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, MO (Divyanshoo R. Kohli, Dhruvil K Radadiya, Prateek Sharma, Madhav Desai).
Pancreas and Liver Clinic, Sacred Heart Medical Center, Spokane WA (Divyanshoo R. Kohli).
Ann Gastroenterol. 2022 Nov-Dec;35(6):592-602. doi: 10.20524/aog.2022.0752. Epub 2022 Oct 17.
Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiological gastrostomy (PRG) are invasive interventions used for enteral access. We performed a systematic review and meta-analysis with assessment of certainty of evidence to compare the risk of adverse outcomes and technical failure between PEG and PRG.
We queried PubMed, EMBASE, and Cochrane from inception through January 2022 to identify studies comparing outcomes of PEG and PRG. The primary outcome was 30-day all-cause mortality; secondary outcomes included the risk of colon perforation, peritonitis, bleeding, technical failure, peristomal infections, and tube-related complications. We performed GRADE assessment to assess the certainty of evidence and leave-one-out analysis for sensitivity analysis.
In the final analysis, 33 studies, including 26 high-quality studies, provided data on 275,117 patients undergoing PEG and 192,691 patients undergoing PRG. Data from high quality studies demonstrated that, compared to PRG, PEG had significantly lower odds of selected outcomes, including 30-day all-cause mortality (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.60-0.95; P=0.02), colon perforation (OR 0.61, 95%CI 0.49-0.75; P<0.001), and peritonitis (OR 0.71, 95%CI 0.63-0.81; P<0.001). There was no significant difference between PEG and PRG in terms of technical failure, bleeding, peristomal infections or mechanical complications. The certainty of the evidence was rated moderate for colon perforation and low for all other outcomes.
PEG is associated with a significantly lower risk of 30-day all-cause mortality, colon perforation, and peritonitis compared to PRG, while having a comparable technical failure rate. PEG should be considered as the first-line technique for enteral access.
经皮内镜下胃造口术（PEG）和经皮放射学胃造口术（PRG）是用于肠内通路的侵入性干预措施。我们进行了一项系统评价和荟萃分析，并评估证据的确定性，以比较PEG和PRG之间不良结局和技术失败的风险。
我们检索了从创刊至2022年1月的PubMed、EMBASE和Cochrane数据库，以识别比较PEG和PRG结局的研究。主要结局是30天全因死亡率；次要结局包括结肠穿孔、腹膜炎、出血、技术失败、造口周围感染和与导管相关的并发症的风险。我们进行了GRADE评估以评估证据的确定性，并进行留一法分析以进行敏感性分析。
在最终分析中，33项研究（包括26项高质量研究）提供了275,117例行PEG患者和192,691例行PRG患者的数据。高质量研究的数据表明，与PRG相比，PEG在特定结局方面的几率显著更低，包括30天全因死亡率（优势比[OR]0.75，95%置信区间[CI]0.60-0.95；P=0.02）、结肠穿孔（OR 0.61，95%CI 0.49-0.75；P<0.001）和腹膜炎（OR 0.71，95%CI 0.63-0.81；P<0.001）。PEG和PRG在技术失败、出血、造口周围感染或机械并发症方面无显著差异。结肠穿孔证据的确定性被评为中等，所有其他结局的确定性为低。
与PRG相比，PEG的30天全因死亡率、结肠穿孔和腹膜炎风险显著更低，而技术失败率相当。PEG应被视为肠内通路的一线技术。
