Reduced Risk of Peristomal Infection of Direct Percutaneous Endoscopic Gastrostomy in Cancer Patients: Comparison with the Pull Percutaneous Endoscopic Gastrostomy Procedure

BACKGROUND: Although pull percutaneous endoscopic gastrostomy (Pull-PEG) is a commonly used procedure, peristomal Infection and tumor implantation are considered unavoidable complications of this procedure as the instrument passes through the oral cavity. A novel extracorporeal PEG technique, Direct-PEG, has been developed to reduce the risk of peristomal infection and implantation. STUDY DESIGN: The Direct-PEG procedure was performed on 87 patients from April 2006 to April 2007 in a single, high-volume cancer center in Japan. To compare the surgical outcomes of Direct-PEG and Pull-PEG, the clinical outcomes of Direct-PEG, such as peristomal infection, were retrospectively collected and compared with those of 64 patients having Pull-PEG procedures from April 2005 to March 2006. RESULTS: The mean operation time for the Direct-PEG group (13 +/- 1 minutes) was comparable to that for the Pull-PEG group (12 +/- 1 minutes), and the mean visual analogue pain score during surgery was lower for the Direct-PEG group (3.5 +/- 1.7) than for the Pull-PEG group (24.6 +/- 3.6; p < 0.001). The incidence of peristomal infection was lower in the Direct-PEG group 0%) than in the Pull-PEG group (9%; p = 0.001). Although the most common major underlying disease in the groups was oropharyngeal or esophageal tumor, tumor implantation was not observed in either group. CONCLUSIONS: Direct-PEG may be superior to the Pull-PEG method for a high-volume cancer center because of reduced risks of infection. (J Am Coll Surg 2008;207:737-744. (C) 2008 by the American College of Surgeons)