LB089 - THE ROLE OF PUSH-PEG IN REDUCING THE NEED FOR SURGICAL GASTROSTOMY IN PATIENTS WITH TUMOR-RELATED DYSPHAGIA: A SINGLE-CENTER EXPERIENCE

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LB089

THE ROLE OF PUSH-PEG IN REDUCING THE NEED FOR SURGICAL GASTROSTOMY IN PATIENTS WITH TUMOR-RELATED DYSPHAGIA: A SINGLE-CENTER EXPERIENCE

Á. Tarpay1,*, C. Lőrinczi1, G. Sütő1, M. Egyedné Bihari1, A. Vilandné Horányi1, R. Szmola1

1Dep. of Invasive Gastroenterology, National Institute of Oncology, Budapest, Hungary

 

Rationale: In advanced oropharyngeal and esophageal malignancies, severe stenosis or trismus may make conventional pull-PEG placement technically unfeasible. Ultrathin endoscope-assisted push-PEG may offer a minimally invasive alternative to surgical gastrostomy in these challenging cases.

 

Methods: We performed a retrospective analysis of a 10-year institutional database of patients undergoing PEG placement for tumor-related dysphagia. Primary pull-PEG and push-PEG procedures were recorded. Cases requiring a second intervention within 30 days after primary pull-PEG placement were analyzed separately. Secondary interventions were categorized as surgical gastrostomy or push-PEG. Two periods were compared: 2012–2016 and 2017–2021.

Results: Overall, 205 patients underwent primary PEG placement: 151 pull-PEG and 54 push-PEG procedures. A second intervention was required in 45 cases (22%). After primary pull-PEG placement, 26 patients required a second intervention within 30 days. The pattern of secondary interventions changed over time. In 2012–2016, surgical gastrostomy accounted for 71% of secondary interventions (n=5), while push-PEG accounted for 29% (n=2). In 2017–2021, push-PEG became the dominant strategy, accounting for 74% of cases (n=14), while surgical gastrostomy was required in 26% (n=5).

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Conclusion: The introduction of ultrathin endoscope-assisted push-PEG was associated with a marked reduction in the need for surgical gastrostomy after failed pull-PEG placement in patients with tumor-related dysphagia. Push-PEG appears to be a safe, minimally invasive step-up option for securing enteral access in technically difficult cases.

Disclosure of Interest: None declared