经皮内镜下胃造口与影像下插入胃造口：澳大利亚教学医院结局比较

　　肠内营养（EN）在临床上是患者能够耐受前提下首选的营养支持方式。胃造口管饲是EN最常见的方法之一，目前主要有经皮内镜下胃造口（PEG）和影像下插入胃造口（RIG）等方法。研究表明这两种胃造口方式并发症发生率都较低，且发病率和死亡率也较为相似。也有研究发现RIG比PEG具有更高的管脱落率。

　　澳大利亚弗林德斯医疗中心回顾分析了2013年2月～2015年2月放置PEG（n=85）或RIG（n=52）行EN的患者。

　　结果发现，RIG与PEG相比，管脱落率较高（26.5%比2.4%，P＜0.001），两组患者30天死亡率无统计学差异（P=0.48），但RIG的一年死亡率显著高于PEG组（46.2%比16.7%，P＜0.05）。

JPEN J Parenter Enteral Nutr. 2017;41(2):272-273.

Percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy: a comparison of outcomes at an australian teaching hospital.

Vidhya Chandran; Phoebe Dunsmuir; Dhina Chandran; Robert Fraser.

Flinders Medical Centre, Adelaide, South Australia, Australia.

PURPOSE: Enteral feeding is the preferred route of artificial nutrition where gut function is maintained due to better immunological and nutrition outcomes compared with parenteral feeding. Gastrostomy tubes for enteral nutrition (EN) are most commonly inserted via percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) techniques. Both methods are associated with low complication rates and enable rapid discharge postinsertion. Studies comparing outcomes between PEGs and RIGs have shown similar morbidity and mortality outcomes, although it has recently been reported that higher tube dislodgement rates are seen with RIG compared with the PEG placement. The current study aimed to compare clinical outcomes and complication rates in patients who underwent PEG and RIG procedures at a tertiary teaching hospital in Australia.

METHODS: A retrospective review was conducted on patients who underwent PEG or RIG tube insertion between February 2013 and February 2015 at Flinders Medical Centre, Australia. Gastrostomy tubes with an internal flange were used for PEG insertions and balloon-tipped tubes were used for RIGs. Patient demographics and procedure indications were recorded. The primary outcome studied was the tube dislodgement rate. Secondary outcomes measured included hospital length of stay, 30-day and 1-year mortality, and periprocedural and postprocedural complications such as hypoxia, bleeding, stoma site infection, and hematoma. Statistical analysis was performed using SPSS version 20.0 and baseline comparisons were conducted using the Mann-Whitney test and χ² test.

RESULTS: In total, 137 patients (PEG = 85, RIG = 52) underwent gastrostomy tube insertion. The mean ages were 65 and 64 years, respectively, P = .61. The main indications for insertion were head and neck cancer (PEG = 30, RIG = 21), stroke (PEG = 27, RIG = 11), posttrauma (PEG = 6, RIG = 3), and neuromuscular pathologies (PEG = 9, RIG = 0). The time from gastrostomy insertion to hospital discharge was 9 days in the PEG group (range 0-190) compared with 6 days in the RIG group (range 1-149), P = .69. There was a significantly higher tube dislodgement rate in RIG (26.5%) compared with PEG (2.4%), P < .001. The 1-year mortality was also significantly higher after RIG (46.2%) compared with the PEG group (16.7%), P < .05. No differences were seen in other periprocedural and postprocedural complications. The 30-day mortality rates were similar in both groups (PEG = 4.8%, RIG = 7.7%, P = .48).

CONCLUSIONS: The rates of tube dislodgement were significantly higher in the RIG group, which could be secondary to the tube design. The balloon-tipped tubes tend to rupture more easily, leading to early dislodgement. This supports using an endoscopic approach where possible. The higher mortality rate at 1 year after RIG placement may be related to patient selection, particularly as no differences were seen at 30 days.

DOI: 10.1177/0148607116686023