title: Gastrostomy tube placement outcomes: comparison of surgical, endoscopic, and laparoscopic methods.
abstract: BACKGROUND
  Advances in percutaneous endoscopic gastrostomy (PEG) and laparoscopic (LAP) techniques now allow for less invasive placement of gastrostomy tubes. This study compared morbidities and feeding outcomes of these procedures with standard surgical (OPEN) insertion.
  
  
  METHODS
  Gastrostomy tubes placed in the operating room by the PEG, LAP, and OPEN methods were compared for insertion times, tube insertion and maintenance complications, enteral feeding complications, and feeding start days. Patients with concomitant intra-abdominal procedures were excluded. Patients were followed for 6 days after tube placement.
  
  
  RESULTS
  A total of 91 catheters (PEG = 23, LAP = 39, OPEN = 29) were inserted in the operating room for indications of ventilator-dependent respiratory failure (45), dysphagia (30), head and neck cancer (9), and decreased mental status (7). No patients were fed on the day of the procedure. Insertion times were significantly longer (p < .05) in the OPEN technique (68 minutes) vs LAP (48 minutes) and PEG (30 minutes). Insertion complications occurred in the LAP and PEG cohorts (3 failed LAP, 1 failed PEG), and maintenance complications were higher in the LAP group, including 1 episode each of cellulitis, bleeding, and serous drainage. Twenty enteral feeding complications in 17 patients occurred in all groups (9 in LAP vs 6 in PEG and 5 in OPEN), and included emesis (6), high residual (5), diarrhea (3), ileus (3), nausea (2), and pain after feeding (1). Overall complications were significantly lower in the PEG (7) and OPEN (5) groups compared with the LAP group (15). Feeding start day was significantly delayed in the OPEN technique (2.1 days vs 1.7 in PEG and 1.5 in LAP); however, no difference was found in days to goal among groups (4.4-4.8 days).
  
  
  CONCLUSIONS
  PEG should be the procedure of choice for placement of gastrostomy tubes. If PEG is contraindicated, then OPEN technique may be best due to fewer complications, although insertion time is longer than the LAP technique.
authors.affiliation: Department of Surgery, Temple University Hospital, Philadelphia, PA 19140, USA. robin.bankhead@tuhs.temple.edu
authors.forename: Robin Rago
authors.initials: RR
authors.lastname: Bankhead
authors.forename: Carol A
authors.initials: CA
authors.lastname: Fisher
authors.forename: Rolando H
authors.initials: RH
authors.lastname: Rolandelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome