INTRODUCTION A gastrostomy is generally performed in patients who are unable to maintain volitional intake of food. We compared outcomes of percutaneous endoscopic gastrostomy (PEG) and interventional radiologist-guided gastrostomy (IRG) using an integrated nationwide database. METHODS Using the VA Informatics and Computing Infrastructure database, patients who underwent PEG or IRG from 2011 through 2021 were selected using Current Procedural Terminology and International Classification of Diseases codes. The primary outcome was the comparative incidence of adverse events between PEG and IRG. Secondary outcomes included all-cause mortality. Comorbidities were identified using International Classification of Diseases codes, and adjusted odds ratio (OR) for adverse events were calculated using multivariate logistic regression analysis. RESULTS A total of 23,566 (70.7 ± 10.2 years) patients underwent PEG and 9,715 (69.6 ± 9.7 years) underwent IRG. Selected frequent indications for PEG vs IRG were as follows: stroke, 6.8% vs 5.3%, P < 0.01; aspiration pneumonia, 10.9% vs 6.8%, P < 0.001; feeding difficulties, 9.8% vs 6.3%, P < 0.01; and upper aerodigestive tract malignancies 58.8% vs 79.8%, P < 0.01. Across all subtypes of malignancies of the head and neck and foregut, the proportion of patients undergoing IRG was greater than those undergoing PEG (P < 0.001). The all-cause 30-day mortality and overall incidence of adverse events were significantly lower for PEG compared with those for IRG (PEG vs IRG): all-cause 30-day mortality, 9.35% vs 10.3% (OR 0.80; 95% confidence interval [CI] 0.74-0.87; P < 0.01); perforation of the colon, 0.12% vs 0.24% (OR 0.50; 95% CI 0.29-0.86; P = 0.04); peritonitis, 1.9% vs 2.7% (OR 0.68; 95% CI 0.58-0.79; P < 0.01); and hemorrhage 1.6% vs 1% (OR 1.47; 95% CI 1.18-1.83; P < 0.01). DISCUSSION In a large nationwide database of more than 33,000 gastrostomy procedures, PEG was associated with a lower incidence of adverse outcomes and the 30-day mortality than IRG.

中文翻译：

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内窥镜与放射胃造口管放置的安全性比较：来自大型全国退伍军人事务数据库的结果。

简介 胃造口术通常针对无法维持自主进食的患者进行。我们使用全国综合数据库比较了经皮内窥镜胃造口术 (PEG) 和介入放射科医生引导胃造口术 (IRG) 的结果。方法 使用 VA 信息学和计算基础设施数据库，使用当前程序术语和国际疾病分类代码选择 2011 年至 2021 年接受 PEG 或 IRG 的患者。主要结果是 PEG 和 IRG 之间不良事件发生率的比较。次要结局包括全因死亡率。使用国际疾病分类代码识别合并症，并使用多元逻辑回归分析计算不良事件的调整优势比（OR）。结果 共有 23,566 名患者（70.7 ± 10.2 岁）接受了 PEG 治疗，9,715 名患者（69.6 ± 9.7 岁）接受了 IRG。PEG 与 IRG 的选定常见适应症如下：中风，6.8% vs 5.3%，P < 0.01；吸入性肺炎，10.9% vs 6.8%，P < 0.001；喂养困难，9.8% vs 6.3%，P < 0.01；上呼吸消化道恶性肿瘤 58.8% vs 79.8%，P < 0.01。在头颈和前肠恶性肿瘤的所有亚型中，接受 IRG 的患者比例大于接受 PEG 的患者比例 (P < 0.001)。与 IRG 相比，PEG 的全因 30 天死亡率和不良事件总体发生率显着降低（PEG 与 IRG）：全因 30 天死亡率，9.35% vs 10.3%（OR 0.80；95% 置信度）区间 [CI] 0.74-0.87；P < 0.01)；结肠穿孔，0.12% vs 0.24%（OR 0. 50；95% CI 0.29-0.86；P = 0.04）；腹膜炎，1.9% vs 2.7%（OR 0.68；95% CI 0.58-0.79；P < 0.01）；出血率为 1.6% vs 1%（OR 1.47；95% CI 1.18-1.83；P < 0.01）。讨论 在包含超过 33,000 例胃造口术手术的大型全国数据库中，与 IRG 相比，PEG 与较低的不良后果发生率和 30 天死亡率相关。