PMID- 37948117 OWN - NLM STAT- MEDLINE DCOM- 20231216 LR - 20240409 IS - 2050-6414 (Electronic) IS - 2050-6406 (Print) IS - 2050-6406 (Linking) VI - 11 IP - 10 DP - 2023 Dec TI - To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients. PG - 951-959 LID - 10.1002/ueg2.12467 [doi] AB - BACKGROUND: The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction. OBJECTIVE: We aimed to compare the efficacy and safety of both PEG procedures in cancer patients. METHODS: We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG. RESULTS: We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [+/-10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] = 2.9; 95% CI = 1.9-4.3, p < 0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio = 2.7, 95% CI = 1.0-7.2, p = 0.042). CONCLUSION: The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected. CI - (c) 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology. FAU - Kucha, Piotr AU - Kucha P AUID- ORCID: 0000-0003-0664-159X AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. FAU - Zorniak, Michal AU - Zorniak M AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. FAU - Szmit, Mateusz AU - Szmit M AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. FAU - Lipczynski, Rafal AU - Lipczynski R AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. FAU - Wieszczy-Szczepanik, Paulina AU - Wieszczy-Szczepanik P AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. FAU - Kapala, Aleksandra AU - Kapala A AD - Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Wojciechowska, Urszula AU - Wojciechowska U AD - Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Didkowska, Joanna AU - Didkowska J AD - Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Rupinski, Maciej AU - Rupinski M AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. AD - Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Olesinski, Tomasz AU - Olesinski T AD - Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Maj, Tomasz AU - Maj T AD - Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Regula, Jaroslaw AU - Regula J AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. AD - Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Kaminski, Michal F AU - Kaminski MF AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. AD - Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. FAU - Januszewicz, Wladyslaw AU - Januszewicz W AUID- ORCID: 0000-0002-8200-2661 AD - Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland. AD - Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. LA - eng PT - Journal Article DEP - 20231110 PL - England TA - United European Gastroenterol J JT - United European gastroenterology journal JID - 101606807 SB - IM MH - Male MH - Humans MH - Middle Aged MH - Female MH - *Gastrostomy/adverse effects/methods MH - Retrospective Studies MH - *Head and Neck Neoplasms/surgery/etiology MH - Clinical Audit PMC - PMC10720683 OTO - NOTNLM OT - adverse effects OT - enteral nutrition OT - gastrostomy OT - percutaneous endoscopic gastrostomy OT - pull PEG OT - push PEG COIS- The authors have no conflicts of interest to declare. EDAT- 2023/11/10 12:44 MHDA- 2023/12/17 13:19 PMCR- 2023/11/10 CRDT- 2023/11/10 11:54 PHST- 2023/04/03 00:00 [received] PHST- 2023/08/21 00:00 [accepted] PHST- 2023/12/17 13:19 [medline] PHST- 2023/11/10 12:44 [pubmed] PHST- 2023/11/10 11:54 [entrez] PHST- 2023/11/10 00:00 [pmc-release] AID - UEG212467 [pii] AID - 10.1002/ueg2.12467 [doi] PST - ppublish SO - United European Gastroenterol J. 2023 Dec;11(10):951-959. doi: 10.1002/ueg2.12467. Epub 2023 Nov 10.