title: Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances.
abstract: BACKGROUND
  Gastrostomy has been established as the standard procedure for administering long-term enteral nutrition in individuals with swallowing disturbances. Percutaneous gastrostomy is a less-invasive approach than open surgical gastrostomy, and can be accomplished via endoscopy (percutaneous endoscopic gastrostomy or PEG) or sonographic or fluoroscopic guidance (percutaneous radiological gastrostomy or PRG). Both techniques have different limitations, advantages, and contraindications. In order to determine the optimal technique for long-term nutritional supplementation many studies have been conducted to compare the outcomes of these two techniques; however, it remains unclear as to which method is superior to the other with respect to both efficacy and safety.
  
  
  OBJECTIVE
  To compare the safety and efficacy of PEG and PRG in the treatment of individuals with swallowing disturbances.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, January 2016); MEDLINE (1946 to 22 January 2016); EMBASE (1980 to 22 January 2016); the reference lists of identified articles; databases of ongoing trials, including the Chinese Cochrane Centre Controlled Trials Register; and PubMed. We applied no language restrictions.
  
  
  METHODS
  Randomised controlled trials (RCTs) comparing PEG with PRG in individuals with swallowing disturbances, regardless of the underlying disease.
  
  
  METHODS
  Two authors independently evaluated the search results and assessed the quality of the studies. Data analyses could not be performed as no RCTs were identified for inclusion in this review.
  
  
  RESULTS
  We identified no RCTs comparing PEG and PRG for percutaneous gastrostomy in individuals with swallowing disturbances. The large body of evidence in this field comes from retrospective and non-randomised controlled studies and case series. Based on this evidence, both PEG and PRG can be safely performed in selected individuals, although both are associated with major and minor complications. A definitive RCT has yet to be conducted to identify the preferred percutaneous gastrostomy technique.
  
  
  CONCLUSIONS
  Both PEG and PRG are effective for long-term enteral nutritional support in selected individuals, though current evidence is insufficient to recommend one technique over the other. Choice of technique should be based on indications and contraindications, operator experience and the facilities available. Large-scale RCTs are required to compare the two techniques and to determine the optimal approach for percutaneous gastrostomy.
authors.affiliation: Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yuan
authors.forename: Yongfan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Tianpeng
authors.initials: T
authors.lastname: Xie
authors.forename: Yang
authors.initials: Y
authors.lastname: Hu
mesh_terms: D003680:Deglutition Disorders / Q000150:complications*; D004750:Enteral Nutrition / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006801:Humans
references.citation: Arch Surg. 1998 Oct;133(10):1076-83
references.pmid: 9790204
references.citation: Postgrad Med J. 2006 Jun;82(968):383-91
references.pmid: 16754707
references.citation: Otolaryngol Clin North Am. 2009 Feb;42(1):87-105, ix
references.pmid: 19134493
references.citation: Radiology. 2002 Sep;224(3):713-7
references.pmid: 12202704
references.citation: Semin Intervent Radiol. 2004 Sep;21(3):191-7
references.pmid: 21331128
references.citation: Clin Radiol. 2003 May;58(5):398-405
references.pmid: 12727170
references.citation: J Am Med Dir Assoc. 2008 Sep;9(7):523-31
references.pmid: 18755427
references.citation: Scand J Gastroenterol. 1999 Oct;34(10):1050-4
references.pmid: 10563677
references.citation: Amyotroph Lateral Scler Other Motor Neuron Disord. 2005 Jun;6(2):88-93
references.pmid: 16036431
references.citation: Gastrointest Endosc. 1992 May-Jun;38(3):314-8
references.pmid: 1607082
references.citation: Gastrointest Endosc. 1998 Dec;48(6):699-701
references.pmid: 9852479
references.citation: Nutrition. 2003 Jul-Aug;19(7-8):605-11
references.pmid: 12831946
references.citation: Health Technol Assess. 2006 Jan;10(2):iii-iv, ix-x, 1-120
references.pmid: 16409880
references.citation: Surg Oncol. 2006 Dec;15(4):199-203
references.pmid: 17280829
references.citation: Turk J Gastroenterol. 2011;22(2):128-33
references.pmid: 21796547
references.citation: Age Ageing. 2005 Jul;34(4):353-7
references.pmid: 15901578
references.citation: Lancet. 2005 Feb 26-Mar 4;365(9461):764-72
references.pmid: 15733717
references.citation: Clin Otolaryngol. 2009 Apr;34(2):103-12
references.pmid: 19413607
references.citation: J Head Trauma Rehabil. 2009 Sep-Oct;24(5):384-91
references.pmid: 19858972
references.citation: Cochrane Database Syst Rev. 2009 Apr 15;(2):CD007209
references.pmid: 19370678
references.citation: Br J Oral Maxillofac Surg. 2011 Oct;49(7):516-20
references.pmid: 20952109
references.citation: J Vasc Interv Radiol. 1999 Apr;10(4):413-20
references.pmid: 10229468
references.citation: Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004030
references.pmid: 21249659
references.citation: Nutrition. 2001 Nov-Dec;17(11-12):967-8
references.pmid: 11744349
references.citation: Eur J Clin Nutr. 2013 Jan;67(1):47-52
references.pmid: 23169469
references.citation: J Craniomaxillofac Surg. 2010 Jan;38(1):60-3
references.pmid: 19836255
references.citation: Rev Neurol (Paris). 2006 Jun;162 Spec No 2:4S177-4S187
references.pmid: 17128108
references.citation: Invest Radiol. 1983 Sep-Oct;18(5):485-7
references.pmid: 6642944
references.citation: Am J Gastroenterol. 1990 Dec;85(12):1560-3
references.pmid: 2252016
references.citation: Lancet Neurol. 2006 Jan;5(1):16-7
references.pmid: 16361015
references.citation: Eur J Gastroenterol Hepatol. 2010 May;22(5):591-6
references.pmid: 19966570
references.citation: Br J Radiol. 2002 Apr;75(892):371-7
references.pmid: 12000697
references.citation: Endoscopy. 1999 Feb;31(2):207-8
references.pmid: 10223373
references.citation: J Gen Intern Med. 1997 Feb;12(2):88-94
references.pmid: 9051557
references.citation: J Vasc Interv Radiol. 2010 Apr;21(4):527-33
references.pmid: 20172742
references.citation: J Neurol. 2007 Oct;254(10):1323-9
references.pmid: 17361338
references.citation: Acta Otolaryngol. 2004 Sep;124(7):847-50
references.pmid: 15370571
references.citation: Cardiovasc Intervent Radiol. 1998 Jul-Aug;21(4):324-8
references.pmid: 9688801
references.citation: Cardiovasc Intervent Radiol. 2005 Nov-Dec;28(6):692-703
references.pmid: 16184329
references.citation: ANZ J Surg. 2003 Aug;73(8):590-3
references.pmid: 12887525
references.citation: Cardiovasc Intervent Radiol. 2000 Jul-Aug;23(4):279-84
references.pmid: 10960541
references.citation: J Pediatr Surg. 2010 Jun;45(6):1153-8
references.pmid: 20620311
references.citation: Radiology. 1999 Mar;210(3):651-4
references.pmid: 10207463
references.citation: Surg Endosc. 2013 Apr;27(4):1186-95
references.pmid: 23232989
references.citation: J Trauma. 2002 Jan;52(1):26-32
references.pmid: 11791048
references.citation: Can J Gastroenterol. 2009 Feb;23(2):109-14
references.pmid: 19214286
references.citation: J Pediatr Surg. 1980 Dec;15(6):872-5
references.pmid: 6780678
references.citation: J Hum Nutr Diet. 2010 Aug;23(4):408-15
references.pmid: 20487174
references.citation: Gut Liver. 2010 Sep;4 Suppl 1:S25-31
references.pmid: 21103291
references.citation: AJR Am J Roentgenol. 1997 Dec;169(6):1551-3
references.pmid: 9393163
references.citation: Cardiovasc Intervent Radiol. 1989 Nov-1990 Dec;12(6):340-1
references.pmid: 2516777
references.citation: Dig Dis Sci. 2013 Dec;58(12):3558-65
references.pmid: 23975341
references.citation: Clin Nutr. 2005 Oct;24(5):848-61
references.pmid: 16261664
references.citation: J Neurol Neurosurg Psychiatry. 2004 Apr;75(4):645-7
references.pmid: 15026518
references.citation: J Gastroenterol Hepatol. 2000 Jan;15(1):21-5
references.pmid: 10719742
references.citation: Br J Surg. 1990 Aug;77(8):858-62
references.pmid: 2118406
references.citation: Radiology. 1995 Dec;197(3):699-704
references.pmid: 7480742
references.citation: Eur J Gastroenterol Hepatol. 2000 Oct;12(10):1101-9
references.pmid: 11057455
references.citation: Eur J Radiol. 2005 Oct;56(1):84-90
references.pmid: 16168268
references.citation: Gastroenterol Clin North Am. 2009 Sep;38(3):411-31
references.pmid: 19699405
references.citation: J Eval Clin Pract. 2007 Oct;13(5):817-9
references.pmid: 17824878
references.citation: Dig Dis Sci. 1998 Nov;43(11):2549-57
references.pmid: 9824149
references.citation: J Am Med Dir Assoc. 2008 Sep;9(7):455-8
references.pmid: 18755417
references.citation: Radiology. 1992 Jul;184(1):201-5
references.pmid: 1609080
references.citation: Amyotroph Lateral Scler Frontotemporal Degener. 2013 May;14(4):308-14
references.pmid: 23286755
references.citation: Rev Neurol (Paris). 2006 Jun;162 Spec No 2:4S309-4S319
references.pmid: 17128131
references.citation: Brain Inj. 2007 Dec;21(13-14):1411-7
references.pmid: 18066943
references.citation: J Laryngol Otol. 2006 Jun;120(6):463-6
references.pmid: 16772054
references.citation: Nutr Clin Pract. 2013 Jun;28(3):392-9
references.pmid: 23466470
references.citation: Am J Surg. 1994 Dec;168(6):587-90; discussion 590-1
references.pmid: 7978001
references.citation: JPEN J Parenter Enteral Nutr. 2004 May-Jun;28(3):154-7
references.pmid: 15141407
references.citation: Zhonghua Wei Chang Wai Ke Za Zhi. 2010 Aug;13(8):598-600
references.pmid: 20737313
references.citation: Surg Gynecol Obstet. 1981 May;152(5):658-60
references.pmid: 6784260
references.citation: J Oral Maxillofac Surg. 2003 Nov;61(11):1279-84
references.pmid: 14613083
references.citation: Support Care Cancer. 1993 Sep;1(5):272-5
references.pmid: 8156240
references.citation: Clin Oncol (R Coll Radiol). 2003 May;15(3):87-91
references.pmid: 12801043