P1065 - PUSH-PEG VERSUS PULL-PEG IN PEDIATRIC PATIENTS: A RETROSPECTIVE STUDY COMPARING CLINICAL OUTCOMES AND COST IMPLICATIONS.

P1065

PUSH-PEG VERSUS PULL-PEG IN PEDIATRIC PATIENTS: A RETROSPECTIVE STUDY COMPARING CLINICAL OUTCOMES AND COST IMPLICATIONS.

O. Mollema^1,*, R. Visschers¹, D. Dinjens¹, W. van Gemert¹

¹Department of pediatric surgery, Maastricht University Medical Center, Maastricht, Netherlands

Rationale: One-step percutaneous endoscopic gastrostomy (Push-PEG) is safe and feasible compared to Pull-PEG in pediatric patients. The literature suggests that the technique also results in lower costs as it avoids a second procedure requiring hospitalization. However, the financial consequences of clinical outcomes were not included in the cost allocation. Therefore, the current study aims to test the hypothesis that Push-PEG is associated with lower costs compared to pull-PEG, including preoperative, perioperative, and postoperative outcomes.

Methods: This retrospective, single-center observational study was conducted at the Maastricht University Medical Center in the Netherlands. Patients (0 – 18 years) who underwent Push-PEG or Pull-PEG between January 2015 and November 2024 were assessed for eligibility. Clinical and financial data were extracted from electronic medical records between December 2024 and March 2025. Extracted costs were converted to 2024 euros (€). Data analysis was performed using the Chi-Square, Fisher's exact, or Mann-Whitney U test when appropriate. Statistical significance was set at p <.05.

Results: Significant differences were found between Push-PEG (N=129) and Pull-PEG (N=50). Push-PEG reduced total costs per gastrostomy by 36% (p <.001), which was confirmed by a generalized linear model adjusting for potential confounders. Furthermore, Push-PEG reduced operative time, anesthesia time, and length of hospital stay by 34%, 41%, and 50%, respectively (p <.001). No significant differences were found in postoperative complications (p = .260). However, power may be limited due to a small sample size.

Conclusion: This retrospective cohort study shows that Push-PEG is associated with significantly lower costs, taking into account clinical outcomes. Furthermore, Push-PEG results in a lower clinical burden for pediatric patients compared to Pull-PEG.

Disclosure of Interest: None declared