CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(01): E29-E35
DOI: 10.1055/s-0043-121879
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Usage characteristics and adverse event rates ​of the direct puncture and pull techniques for percutaneous endoscopic gastrostomy in patients with malignant tumors of the upper aerodigestive tract

Niels Teich1, 2, 3, Lars Selig4, Susanne Liese5, Franziska Schiefke6, 7, Alexander Hemprich6, Joachim Mössner4, Ingolf Schiefke1, 8
  • 1Klinikum St. Georg, Klinik für Gastroenterologie und Hepatologie, Leipzig, Germany
  • 2Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten, Leipzig, Germany
  • 3Medizinische Fakultät der Friedrich-Schiller-Universität Jena, Jena
  • 4Universität Leipzig, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Leipzig, Germany
  • 5Universität Rostock, Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Rostock, Germany
  • 6Universität Leipzig, Klinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, Leipzig, Germany
  • 7Gemeinschaftspraxis für Mund-, Kiefer- und Gesichtschirurgie am Johannisplatz, Leipzig, Germany
  • 8Gastroenterologie und Hepatologie am Johannisplatz, Leipzig, Germany
Further Information

Publication History

submitted 14 May 2017

accepted after revision 12 September 2017

Publication Date:
12 January 2018 (online)


Background and study aims Patients with malignant tumors of the upper gastrointestinal tract are at risk of weight loss. Early supportive nutrition therapy is therefore recommended and usually requires placement of a percutaneous endoscopic gastrostomy (PEG). The aim of this study was to compare adverse events and usage characteristics of the direct puncture technique with those of the traditional pull technique when used in patients with endoscopically passable tumors. The primary endpoint was the rate of inflammatory adverse events (AEs) at the gastrostomy fistula. The secondary endpoint was the long-term rate of puncture-site metastases.

Patients and methods One hundred twenty patients (median age 56; IQR 36, 86 years) were randomized and treated per protocol in this prospective open randomized single-center study. Follow-ups were conducted on the third and seventh post-interventional days, after 1, 3 and 6 months and the last follow-up 5 years after intervention.

Results Within the short-term follow-up period of 6 months after PEG placement, AEs were noted in 47 patients (39.2 %). These included 22 inflammations and 16 device dislocations and were mainly found in the puncture group (33 vs. 14 in the pull group) with a significantly increased incidence in the first month after PEG insertion (P = 0.001). Evaluation of the 5-year data did not reveal any significant differences. The gastrostomy tube was used in 101 patients (84.2 %) (range 18 days to 5 years).

Conclusions Our results favor the pull technique for patients with endoscopically passable tumors of the upper gastrointestinal tract due to less short-term adverse events. Both systems contributed equally to secure long-term use.