title: Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients.
abstract: OBJECTIVE
  Percutaneous access to the stomach can be achieved by endoscopic or fluoroscopic methods. Our objective was to compare indications, complications, efficacy and outcomes of these two techniques.
  
  
  METHODS
  Records of 370 patients with feeding tubes placed either endoscopically by gastroenterology, or fluoroscopically by radiology, at our university-based tertiary care center over a 54-month period were reviewed.
  
  
  RESULTS
  177 gastrostomies were placed endoscopically and 193 fluoroscopically. Nutrition was the most common indication in each group (94 and 92%), but the most common underlying diagnosis was neurologic impairment in the endoscopic group (n=89, 50%) and malignancy in the fluoroscopic group (n=134, 69%) (p<0.001). Complications in the first 30 days were more common with fluoroscopic placement (23% versus 11%, p=0.002), with infection most frequent. Correlates of late complications were inpatient status (OR 0.26, 95%CI: 0.13-0.51) and a diagnosis of malignancy (OR 2.2, 95%CI: 1.03-4.84). Average follow-up time was 108 days in the fluoroscopic group and 174 days in the endoscopic group.
  
  
  CONCLUSIONS
  Both endoscopic and fluoroscopic gastrostomy tube placement are safe and effective. Outpatient status was associated with greater early and late complication rates; minor complications such as infection were greater in the fluoroscopic group, while malignancy was associated with late complications.
authors.affiliation: Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. anne.m.silas@hitchcock.org
authors.forename: Anne M
authors.initials: AM
authors.lastname: Silas
authors.forename: Lindsay F
authors.initials: LF
authors.lastname: Pearce
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Lestina
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Grove
authors.forename: Anna
authors.initials: A
authors.lastname: Tosteson
authors.forename: Wendy D
authors.initials: WD
authors.lastname: Manganiello
authors.forename: Michael A
authors.initials: MA
authors.lastname: Bettmann
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
mesh_terms: D000368:Aged; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010045:Outpatients / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D015642:Radiology, Interventional / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome