Prior gastropexy does not reduce peristomal infection after pull-method percutaneous endoscopic gastrostomy

Abstract Percutaneous endoscopic gastrostomy (PEG) has become the standard method for providing enteral nutrition, with peristomal infection being one of its most common complications. The aim of the present prospective trial was to evaluate if gastropexy prior to PEG placement can reduce infection rate. This randomized-controlled study included patients who underwent PEG insertion between June 2020 and July 2022. Patients were randomized 1:1 into two groups: pull method without (Group 1) and with gastropexy (Group 2). Key outcomes, including peristomal infection rates after 21 days and up to one year, overall procedure times, and complications were compared between the two groups. A total of 122 patients were enrolled. The peristomal infection rate within 21 days did not differ significantly between groups: 18/61 patients (30%) without gastropexy versus 14/61 patients (23%) with gastropexy (absolute risk difference [ARD] 7%, 95%-CI − 8% to 22%; p > 0.2). In the secondary long-term analysis, infection requiring antibiotic therapy after the first month occurred in 8 patients (16%) without versus 3 patients (5%) with gastropexy (ARD 11%, 95%-CI 1% to 21%; p = 0.04). In a multivariate analysis, gastropexy was not an independent predictor of infection, whereas preprocedural antibiotic prophylaxis ( p = 0.045) and self-sustaining care after discharge ( p = 0.016) were independently associated with a lower infection rate. The gastropexy group required significantly more time for placement (median 18 vs. 13 min; p = 0.001). In this first prospective randomized-controlled trial of gastropexy prior to pull-method PEG placement, the addition of gastropexy did not significantly reduce the rate of short-term peristomal infection. Fewer long-term infections occurred with gastropexy, but this exploratory difference disappeared after accounting for post-discharge care. Our data identify post-discharge care as a key determinant of peristomal infection, underlining that structured PEG care after placement is more important than the insertion technique itself. Clinical trial registration: This is a prospective, randomized-controlled clinical trial (superiority framework). The trial was registered before enrollment started at clinicaltrials.gov (NCT04476498; date of first registration: [15/07/2020]; URL: https://clinicaltrials.gov/study/NCT04476498 ).