Comparing Outcomes of Per-Oral Image-Guided Gastrostomy With Radiologically Inserted Gastrostomy at a Quaternary Australian Hospital.

Abstract

Introduction: Per-oral Image-guided gastrostomy (PIG) is an alternative to conventional radiologically inserted gastrostomy (RIG). PIG is less frequently used in Australia, despite a favourable complication profile reported within the literature. This case control study compares success and complication rates of these procedures at a quaternary Australian Hospital.

Methods: Retrospective review of electronic medical records (EMR) was performed for patients undergoing radiological-guided gastrostomy between January 2019 and January 2023. Clinical notes, operation reports, radiology reports and discharge summaries at the time and for subsequent readmissions within 3 months were reviewed. Outcomes measured included procedural indication, technical success rate, major and minor complications, readmission or death within 3 months.

Results: 216 radiological guided gastrostomies were attempted (age 65.6 ± 12.6; range 20-93; 81 female and 135 male). Sixteen cases were abandoned prior to insertion. Gastrostomy was successful in 133/136 PIG (97.8%) and 63/64 RIG (98.4%). The most frequent indication for PIG was dysphagia secondary to Motor Neuron Disease (107/136) and for RIG was head and neck malignancy (41/64). There were significantly more major complications (15.6% vs. 6.6%, p = 0.043) and minor complications (14.0% vs. 2.9%, p = 0.003) with RIG compared to PIG. Tube malpositioning, leak/peritonitis, aspiration pneumonitis and tube dislodgement were significantly increased in RIG. There was no significant difference in readmission rate (5.1% for PIG vs. 9.4% for RIG) or mortality (2.2% vs. 7.8%).

Conclusion: Compared to conventional RIG, PIG showed a similar primary success rate and decreased incidence of both major and minor complications.