Radiologic gastrojejunostomy and percutaneous endoscopic gastrostomy: a prospective, randomized comparison.
OBJECTIVE
To compare the efficacy of radiologic guided placement of percutaneous gastrojejunostomy (PGJ) and percutaneous endoscopic gastrostomy (PEG).


METHODS
Patients were randomized to PGJ (n = 66) or PEG (n = 69). Indications for gastrostomy were need for prolonged enteral nutrition (97%) or gastrointestinal decompression (3%), with etiologies of neurologic impairment (81%), head and neck neoplasm (12%), bowel obstruction (3%), or other (4%). Mean follow-up was 202 days and 30-day follow-up was obtained for 85% of patients.


RESULTS
PEG was successful in 63 of 69 (91%) patients, while PGJ established access in all of 66 attempts (100%) (P = .014). Average procedural time was 53 minutes for PGJ and 24 minutes for PEG (P = .001). At 30-day follow-up, there were 33 and 45 complications in the PGJ and PEG groups, respectively. This difference was due to the greater incidence of pneumonia in the PEG group (P = .013). Long-term tube-related complications occurred with 17 PGJs and four PEGs (P = .007). The PGJ cost more than PEG, but this advantage was offset by the cost of complications.


CONCLUSIONS
PGJ had higher success rate and fewer complications, due to a lower incidence of pneumonia. PEG took less time to perform, cost less, and required less tube maintenance.
Hoffer
E K
EK
Department of Radiology, Kings County Hospital Center, Brooklyn, New York, USA.
Cosgrove
J M
JM
Levin
D Q
DQ
Herskowitz
M M
MM
Sclafani
S J
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D004750:Enteral Nutrition / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D005774:Gastrostomy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000191:economics / Q000379:methods; D007582:Jejunostomy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology; D011446:Prospective Studies; D015641:Radiography, Interventional; D013997:Time Factors; D016896:Treatment Outcome