S3150 Validation of ASGE Guidelines 2025 on the Modality of Gastrostomy Feeding Placement in Patients With Malignant Dysphagia

Introduction: The 2025 American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend percutaneous endoscopic gastrostomy (PEG) and interventional radiologist-guided gastrostomy (IR-G) as preferred methods for enteral access in patients with malignant dysphagia. However, comparative outcome data remain limited. This study evaluates these recommendations using national data to assess procedural efficacy and safety in this vulnerable population. Methods: Using the National Readmission Database (NRD), we identified adult inpatients (aged ≥18 years) with malignant dysphagia undergoing gastrostomy, based on International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Patients were categorized into three groups: PEG, IR-G and open surgical gastrostomy. Outcomes were compared using multivariable regression analysis. Results: Of 34,059 adult patients with malignant dysphagia undergoing gastrostomy, 85.4% received IR-G, 9.0% underwent open surgical gastrostomy, and 5.6% had PEG. Compared to PEG, open surgical gastrostomy was associated with significantly higher odds of inpatient mortality (adjusted odds ratio (aOR) 1.57; P = 0.041), gastrostomy tube malfunction (aOR 2.57; P < 0.001), gastrostomy-related infection (aOR 5.47; P < 0.001) and viscus perforation (aOR 5.29; P < 0.01). PEG and IR-G demonstrated comparable clinical outcomes and complication rates, indicating procedural equivalence. The surgical cohort had a longer length of stay by a mean of 1.5 days compared to PEG (P = 0.041), while IR-G was associated with the lowest mean total hospitalization charges. Conclusion: This study supports the 2025 ASGE guidelines, confirming superior safety and mortality outcomes for PEG and IR-G compared to open surgical gastrostomy in patients with malignant dysphagia. IR-G also offers reduced complication rates and lower hospitalization costs. Further studies are needed to investigate long-term outcomes and patient-reported experiences across these gastrostomy methods.