Long‐term risk associations of percutaneous endoscopic gastrostomy and nasogastric tubes: A population‐based cohort study

Abstract Percutaneous endoscopic gastrostomy (PEG) and nasogastric (NG) tubes are commonly used for long‐term enteral feeding in older patients with swallowing difficulties. We conducted a nationwide cohort study (2002–2018) comparing complications between PEG and NG tubes using a 1:1 new‐user design. Post‐procedure outcomes included peritonitis, peptic ulcer, gastrointestinal bleeding, and aspiration pneumonia. The incidence rates per 1000 person‐years for PEG versus NG groups were 3.52 versus 4.53 for peritonitis, 4.67 versus 8.62 for peptic ulcer, 7.65 versus 8.59 for GI bleeding, and 15.4 versus 9.04 for aspiration pneumonia. After adjusting for confounders, PEG was not associated with significant risks compared to NG. However, patients with chronic kidney disease (CKD) had a higher risk of aspiration pneumonia with PEG feeding (HR 3.03, 95% CI 1.02–8.99). Our findings suggest that PEG is the recommended approach for patients needing extended tube feeding support and careful patient selection and close monitoring, especially for CKD patients, are crucial post‐PEG placement. These real‐world data contribute to clinical decision‐making on enteral access options, but further studies on interventions to reduce complications are needed.