Analysis Of The Pull And Introducer Percutaneous Endoscopic Gastrostomy Techniques In 103 Patients

Objective: To investigate the indications and complications of Pull and Introducer techniques for percutaneous endoscopic gastrostomy(PEG),and to analyze their characteristics on enteral nutrition access establishment.Methods: Retrospective analysis design was used.Patients who underwent initial PEG tube insertion between January 2015 and February 2020 at Endoscopy Center of The First Affiliated Hospital of Fujian Medical University 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),including gastric hemorrhage,puncture position hemorrhage,intraperitoneal hemorrhage and aspiration,and minor categories(local or non-life-threatening),including abscess,infection around the fistula,pneumoperitoneum,diarrhea,pain,peritonealleakage,tube dislodgement,tube blockage and others.Results:A total of 125 patients were enrolled,while the percentage of outpatients and inpatients were 17.6%(22/125)and 82.4%(103/125),respectively.And the percentage of inpatients with Pull and Introducer techniques were 82.7%(67/81)and81.8%(36/44),respectively(P=.900).According to the techniques,the inpatients were divided into Pull(P)group(n=67)and Introducer(I)group(n=36).In(P)group and(I)group,inpatients with tube replacement within half year were 1.5%(1/67)and 11.1%(4/36),respectively(P=0.049),while the percentage of patients with carcinoma after surgery or chemotherapy as the primary indication of PEG were 61.2%(41/67)and66.7%(24/36),respectively,(P=0.718).The main locations of tumor were head and neck in(P)group(68.3%,28/41)and esophagus in(I)group(54.2%,13/24),respectively(P=0.036).No signifient difference was found between the two groups in the percentage of overall,major or minor complications(p > 0.05).In esophageal stricture patients with pre-dilation free,complications were found in 62.5%(5/8)in(P)group and in 7.69%(1/13)in(I)group,respectively(P = 0.014).When compared with complication-free patients,Logistic regression analysis showed that the risk factor for major complications was the admission-to-gastrostomy interval(P=0.014)(OR=1.078,95%CI : 1.016-1.145),while that for minor complications was antibiotics absent(P=0.022)(OR= 4.735,95%CI:1.247-17.979).Conclusion: Both Pull and Introducer PEGs have high clinical success rate.Introducer techique may be more suitable for patients with esophageal stricture,while it has a lower incidence of minor complications along with a higher rate of recent tube replacement.Antibiotics application may reduce the incidence of minor complications of PEG,including infection and pain.Early PEG may benefit more for patients with indications.