Percutaneous Endoscopic Gastrostomy Versus Image-Guided Gastrostomy Placement in Patients With Cirrhosis

Background: The selection of an appropriate technique for placement of a gastrostomy tube in patients with cirrhosis remains controversial due to concerns about adverse events. We used real-world data to compare outcomes after percutaneous endoscopic gastrostomy (PEG) versus fluoroscopically guided gastrostomy by an interventional radiologist (IR G-tube) in patients with cirrhosis. Methods: We performed a multicenter retrospective cohort study of adults with cirrhosis who underwent gastrostomy tube placement from 2014 to 2023 using the TriNetX Research Network. Using relevant Current Procedural Terminology codes, patients were categorized into 2 groups: PEG (43246/0DH64UZ) or fluoroscopic IR G-tube (49440/0DH63UZ). Periprocedural adverse events were defined as short-term (14 d) or long-term (180 d). Propensity score matching was performed using demographic, clinical, and available laboratory covariates. Binary outcomes were reported as adjusted odds ratios (aOR) with 95% CIs, whereas mortality was reported using adjusted hazard ratios (aHR) from Cox proportional hazards models. Survival was assessed with Kaplan-Meier analysis and log-rank testing. Results: Of the 5028 patients meeting selection criteria, 1579 underwent PEG placement and 3449 underwent IR G-tube placement. Adjusted odds of periprocedural adverse events for PEG vs IR G-tube were as follows: aspiration pneumonia (aOR: 0.66, 95% CI: 0.51-0.85), hemorrhage (aOR: 0.79, CI: 0.59-1.06), blood transfusion (aOR: 0.99, CI: 0.78-1.27), and infection or peritonitis (aOR: 0.96, CI: 0.68-1.34). In the 6-month follow-up period, PEG placement was associated with lower odds of tube malfunction (aOR: 0.78, 95% CI: 0.64-0.96) and tube replacement (aOR: 0.47, 95% CI: 0.36-0.63). At 6 months, PEG placement was also associated with lower mortality risk (aHR: 0.80, 95% CI: 0.70-0.91; P =0.011). Conclusions: In a large multicenter cohort of patients with cirrhosis, PEG and IR G-tube placement had similar short-term rates of bleeding and infectious adverse events, whereas PEG was associated with fewer tube malfunctions and replacements and lower observed mortality at 6 months.