Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): A comparison of outcomes at an Australian teaching hospital.

Objective: Gastrostomy tubes for enteral nutrition are most commonly inserted via percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) techniques. The current study aimed to compare clinical outcomes and complication rates in patients who underwent PEG and RIG procedures at a tertiary teaching hospital in Australia.

Methods: A retrospective review was conducted on patients who underwent PEG or RIG tube insertion between February 2013 and February 2015 at Flinders Medical Centre, Australia. The primary outcome studied was the tube dislodgement rate. Secondary outcomes measured included hospital length of stay, 30 day and 1 year mortality and peri- and post-procedural complications such as hypoxia, bleeding, stoma site infection and haematoma. Baseline comparisons were conducted using the Mann-Whitney test and chi square test.

Results: 137 patients (PEG = 85, RIG = 52) underwent gastrostomy tube insertion. Indications for insertion were head and neck cancer (PEG = 30, RIG = 21), stroke (PEG = 27, RIG = 11), post-trauma (PEG = 6, RIG = 3) and neuromuscular pathologies (PEG = 9, RIG = 0). There was a significantly higher tube dislodgement rate in RIG (26.5%) compared to PEG (2.4%), p < 0.001. The 1-year mortality was also significantly higher after RIG (46.2%) compared to the PEG group (16.7%), p < 0.05. No differences were seen in other peri- and post-procedural complications.

Conclusion: Although both PEG and RIG insertion techniques compare favourably in terms of the majority of peri and post procedural complications, the rates of tube dislodgement were significantly higher in the RIG group. The higher mortality rate at 1 year after RIG placement may be related to patient selection particularly as no differences were seen at 30 days.