The complication rate, but not the mortality rate, lower after percutaneous endoscopic gastrostomy than after open surgical gastrostomy; comparison of two methods in a high volume group of patients

Introduction
Percutaneous endoscopic gastrostomy (PEG) has become the primary procedure for long-term enteral nutrition of most, but not all patients with dysphagia. Still in some patients gastrostomy may only be performed with open surgical technique (SG). Finally, in some patients due to relative contraindications to both methods, surgeons have to choose one of them.

Aim
To compare PEG with SG in terms of effectiveness and safety.

Material and methods
A retrospective study of 612 patients with dysphagia, who underwent PEG (573) or SG (39) was conducted. Authors analysed effectiveness of PEG and SG procedures as well as the type, frequency and treatment methods of complications classified according to Clavien-Dindo Classification.

Results
The rate of all complications was significantly lower for PEG than for SG and a significant effect of the treatment type on the probability of serious complications was observed – notably lower after PEG (OR = 0.21, 95% CI: 0.05–0.8, p = 0.02). The 30-day mortality rate was 1.74% for PEG and 0% for SG. PEG patients who required laparotomy were over 30 times more likely to die than others. No significant effect of the nutrition status on the probability of serious complications was observed (OR = 0.83, 95% CI: 0.51–1.34, p = 0.46).

Conclusions
A significant effect of the treatment type on the probability of serious complications was confirmed. This result was robust to the preoperative patients’ nutrition status which was found to be insignificant. A lower risk of postoperative complications, a relatively easy procedure make PEG a procedure of choice in patients with dysphagia.