TOPLINE:

Percutaneous endoscopic gastrostomy was associated with lower odds of blood transfusion, colon perforation, and mortality than surgical gastrostomy. The technique was also associated with higher odds of favorable patient-centered outcomes than radiologic gastrostomy but was linked to a high risk for gastrostomy tube infection and malfunction-related complications.

METHODOLOGY:

• Previous studies comparing percutaneous endoscopic, radiologic, and surgical gastrostomy have been limited by single-center scope, small sample sizes, inadequate control for confounding factors, and a lack of generalizability to diverse populations.
• Researchers conducted a retrospective study using data from 146 healthcare organizations worldwide (2005-2024) to examine the safety of percutaneous endoscopic, surgical, and radiologic procedures in hospitalized patients who underwent gastrostomy tube placement.
• They compared three matched cohorts: 10,619 patients in each group for endoscopic vs radiologic gastrostomy, 9011 patients per group for endoscopic vs surgical gastrostomy, and 11,457 patients per group for radiologic vs surgical gastrostomy.
• Some of the outcomes were perforation of the colon, blood transfusion, gastrostomy tube infection, mortality, discharge, and disposition (home vs other).

TAKEAWAY:

• Patients who underwent endoscopic gastrostomy were less likely to require a blood transfusion (P = .001) and to be discharged to a location other than home or to a skilled nursing facility (P < .001 for both) than those who underwent radiological gastrostomy.
• Patients who underwent endoscopic gastrostomy were less likely to experience colon perforation or mortality or to undergo a blood transfusion than patients who underwent surgical gastrostomy (P < .001 for all) but were more likely to develop gastrostomy tube infection and mechanical or malfunction-related complications (P = .001 for both).
• Radiologic gastrostomy was associated with a lower likelihood of colon perforation, mortality, and blood transfusion than surgical gastrostomy but a higher likelihood of discharge to a location other than home or to a skilled nursing facility (P < .001 for all).

IN PRACTICE:

“Our findings suggest that where feasible, PEG [percutaneous endoscopic gastrostomy] should remain the method of choice, with targeted efforts to mitigate risks in patients requiring alternative techniques,” the authors of the study wrote.

SOURCE:

The study was led by Rakahn Haddadin, MD, MountainView Hospital (HCA Healthcare), Las Vegas. It was published online on December 30, 2025, in the Journal of Clinical Gastroenterology.

LIMITATIONS:

The study was mainly limited by its retrospective nature and reliance on administrative coding. The differences in perioperative care, antibiotic protocols, and discharge planning across countries may have influenced outcomes. Additionally, the researchers were unable to fully account for the clinical rationale underlying procedural selection.

DISCLOSURES:

The study was supported (in whole or in part) by HCA Healthcare and/or HCA-employed author(s). The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.