S2217 Comparative Outcomes of Gastrostomy Tube Placement by Gastroenterology vs Interventional Radiology: A Propensity-Matched Analysis of Over 100,000 Patients

Introduction: Gastrostomy tubes are routinely placed for long-term enteral nutrition in patients unable to maintain adequate oral intake. There are 2 ways: percutaneous endoscopic gastrostomy tube by gastroenterology (GI PEG tube) or fluoroscopic placement by interventional radiology (IR G-tube). However, comparative safety and outcome data between the 2 remain limited. Understanding the relative risks associated with each approach is essential for guiding clinical decision-making, especially in complex or high-risk patients. This study compares short-term outcomes of GI vs IR G-tube placement using real-world data from a large, multi-institutional electronic health record (EMR) network. Methods: We conducted a retrospective cohort study using the TriNetX US Collaborative Network, encompassing EMR from 69 healthcare organizations. We included adults (≥18 yrs) who underwent GI PEG (CPT 43246) with IR G-tube (CPT 49440) techniques between 2005 and 2025 with 30 days post-procedure follow-up. Propensity score matching (PSM) (1:1) was performed to control for baseline demographics, comorbidities (e.g., diabetes, CKD, cirrhosis, heart failure), and relevant medications. Primary outcomes included 30-day mortality, hemorrhage, sepsis, infection, tube dislodgement, and 30-day readmission. Risk analyses and Kaplan-Meier survival curves were used to compare outcomes between groups. Results: After PSM, each cohort had 59,454 patients. Interestingly, GI PEG was associated with lower risks of Hemorrhage (0.4% vs 0.6%, OR 0.75); Infection (1.0% vs 1.3%, OR 0.75); 30-day mortality (9.0% vs 9.4%, OR 0.95). However, GI PEG placement was associated with higher risks of 30-day readmission (63.4% vs 59.6%, OR 1.17). Furthermore, there were no significant differences in sepsis (8.1% vs 8.3%, P = 0.42) or tube dislodgement (0.1% in both groups, P = 0.12). Conclusion: This large, propensity-matched cohort study with over 100,000 patients, GI PEG was associated with lower risks of hemorrhage, infection, and 30-day mortality compared to IR G-tube. However, GI PEG placement had higher rates of 30-day readmission. These findings can help in clinical decision-making and highlight important trade-offs between the 2 techniques. It underscores the benefit of GI PEG tube placement over IR G tube, with overall better outcomes, while stressing the need for individualized decision-making based on patient risk profiles and institutional expertise.