A systematic literature review of radiological gastrostomy in adults (1981–2003)

Aims: To investigate the safety of radiological gastrostomy (RG) as an alternative to percutaneous endoscopic gastrostomy (PEG), we have performed a systemic review of the literature from 1981–2003. Methods: An electronic search of Medline and Embase was performed. From 2988 abstracts screened, 35 provided outcome data after RG in adults. Results: 3433 patients were referred for RG (Average age 49y, 65% male). Underlying conditions included stroke (9.0%), other/unspecified neurological conditions (31.0%), head/neck cancer (34.1%), other/unspecified cancer (12.4%), miscellaneous (13.5%). Mean and/or median follow-up was >30days in 22 studies with 2756 patients. Complication rates: dislodgement/migration/recession 6.5% (range between studies 0–63.0%); tube blockage 3.4% (0–56.5%); inflammation/infection 3.3% (0–16.7%); fever/septicaemia 0.5% (0–13.3%); perforation 0.3% (0–5.3%); peritonitis 1.3% (0–11.1%); GI bleeding 0.6% (0–6.7%). Pneumonia occurred in 3.0% of 1524 patients (14 studies). Overall mortality was 13.9% (data provided in 21 studies with 1935 patients). 30d mortality from 23 studies with 2701 patients was 8.8% (0–33.3%). Mortality attributable to RG (from 29 studies with 3097 patients) was 0.7% (0–9.1%). Conclusions: Despite a relatively low rate of serious complications, 30 day mortality was not insignificant. Given the large variation in reported complication rates between studies, further research is required to establish the reasons for variation beyond chance.