title: Comparison of 231 patients receiving either "pull-through" or "push" percutaneous endoscopic gastrostomy.
abstract: BACKGROUND
  A percutaneous endoscopic gastrostomy (PEG) can be performed as a direct stomach puncture, known as Seldinger technique ("push") or a thread pulling method ("pull"). The aim of this study was to compare the final results deriving from both application methods.
  
  
  METHODS
  Data of all pull-through-PEG and push-PEG applications, which had been carried out in our department from 2009 to 2012, were analyzed and compared retrospectively. Data collection included patients' demographics, indications, comorbidities, peri-interventional chemotherapy, and/or radiotherapy. The complications were graded according to the Clavien-Dindo classification and divided in early- and late-term complications (before and after 10 days after PEG insertion).
  
  
  RESULTS
  A total of 231 patients received a PEG. Of these, 131 (56.7 %) were treated with pull-through-PEGs and 100 (43.3 %) with the push-PEG method. Overall, in 61 of 231 (26.4 %) patients, a complication was documented and 37 of 61 (60.6 %) were assigned to Clavien-Dindo grade 1. Only 5 of 231 patients (2.2 %) required a re-intervention or surgical treatment under general anesthesia. The overall complication rate was significantly increased by the type of push-PEG tube used (push 33/100 = 33 vs. pull 28/131 = 21.4 %, p = 0.047). A dislocation of the tube was noticed in 5/131 (3.8 %) cases of pull-PEGs and 12/100 (12 %) cases of push PEGs (p = 0.018). An occlusion of the PEG also occurred significantly more frequent in connection with the push-PEG (10/100 = 10 vs. 1/131 = 0.8 %; p < 0.001).
  
  
  CONCLUSIONS
  Both PEG techniques are safe and well established. Push PEG showed a significantly higher rate of overall complications, dislocations, and occlusions. The decision which PEG tube should be used depends on individual conditions with preference of push-PEGs in patients with head, neck, and esophageal cancer.
authors.affiliation: Department of General and Visceral Surgery, Sisters of Charity Hospital, 4010, Linz, Austria, gernot.koehler@bhs.at.
authors.forename: Gernot
authors.initials: G
authors.lastname: Köhler
authors.forename: Veronika
authors.initials: V
authors.lastname: Kalcher
authors.forename: Oliver O
authors.initials: OO
authors.lastname: Koch
authors.forename: Ruzica-R
authors.initials: RR
authors.lastname: Luketina
authors.forename: Klaus
authors.initials: K
authors.lastname: Emmanuel
authors.forename: Georg
authors.initials: G
authors.lastname: Spaun
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies