S1221 Clinical Outcomes Following Percutaneous Gastrostomy Tube Placement in Patients With Compensated and Decompensated Cirrhosis: A Retrospective Matched Cohort Study

Introduction: Patients with cirrhosis may require long-term enteral nutrition, however, the safety of percutaneous gastrostomy (PG) tube placement in this population remains unclear. We aimed to evaluate the safety of PG tube placement in patients with compensated and decompensated cirrhosis compared to non-cirrhotic controls. Methods: A retrospective cohort study was conducted using the TriNetX database. Current procedural terminology codes were utilized to identify patients who underwent PG, through endoscopic and radiological approaches. Patients were then stratified into 3 groups (compensated, decompensated cirrhosis, and non-cirrhotic controls). Propensity score matching (PSM) (1:1) was conducted based on demographics and relevant comorbidities. Outcomes were assessed within 30 days of the procedure. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated for each outcome. Results: A total of 5,927 cirrhotic patients were identified; of these, 2,297 were compensated, while 3,630 were decompensated. A total of 160,893 patients were identified as controls before PSM. After PSM, when compared to non-cirrhotic controls, the decompensated cirrhosis patients had significantly higher rates of PG related-hemorrhage (aORs 2.37, 95% CI 1.27–4.44), gastrostomy-related malfunctions (aORs 1.68, 95% CI 1.36–2.07), peritonitis (aORs 13.67, 95% CI 8.21–15.79), sepsis (aORs 2.02, 95% CI 1.74–2.34), perforation (aORs 4.44, 95% CI 2.23–8.84), and gastrointestinal (GI) bleeding (aORs 2.99, 95% CI 2.27–3.93). When compared to non-cirrhotic controls, the compensated cirrhosis group had no significant differences in infection (aORs 1.29, 95% CI 0.73–2.29), malfunction (aORs 1.21, 95% CI 0.92–1.61), peritonitis (aORs 1.50, 95% CI 0.72–3.13), sepsis (aORs 1.18, 95% CI 0.96–1.45), perforation (aORs 1.0, 95% CI 0.42–2.41), or GI bleeding (aORs 1.20, 95% CI 0.83–1.75). The overall mortality was higher in compensated (aORs 1.42, 95% CI 1.17–1.72) and decompensated (aORs 1.60, 95% CI 1.37–1.87) groups when compared with controls, which could be related to cirrhosis. Conclusion: Percutaneous gastrostomy tube placement was safe in compensated cirrhosis patients. In contrast, patients with decompensated cirrhosis had significant increased risk of infection, malfunctions, peritonitis, perforations, sepsis, and gastrointestinal bleeding when compared to non-cirrhotic controls. Careful patient selection and peri-procedural management in cirrhotic decompensated patients undergoing PG tube placement are warranted.