Effect of the introducer technique compared with the pull technique on the peristomal infection rate in PEG: a meta-analysis

Background Peristomal infection is a main complication of PEG. The pull technique appears to be associated with higher infection rates compared with the introducer technique, although published results are controversial. Objective To determine which technique is associated with a higher risk of infection. Design Systematic review and meta-analysis. Setting Studies reporting rates of peristomal infection after PEG performed by either the pull or introducer technique. Patients This study involved 2336 patients from 6 comparative and 10 observational studies. Intervention Public MEDLINE (National Library of Medicine journal articles database), Excerpta Medica Database, Cochrane Central Register of Controlled Trials, and Latin American and Caribbean Center on Health Sciences Information databases and proceedings of two meetings, Digestive Disease Week and United European Gastroenterology Week, were searched. Both comparative and observational studies were included and analyzed separately. Main Outcome Measurements Effect measures from each comparative study were reported as the odds ratio (OR). The pooled effect was then calculated. The infection rate in each observational study was also calculated, and a summary effect was then determined. Results In comparative studies, the risk of infection was significantly higher with the pull technique (OR 13.0; 95% confidence interval [CI], 4.6-36.8; P < .0001). Similarly, observational studies also reported higher infection rates with the pull technique (10.7%; 95% CI, 4.9-21.8 with the pull technique vs 0.9%; 95% CI, 0.2-4.5 with the introducer technique). Limitations Few studies were available for inclusion, and there was a high risk of bias among the comparative studies. Conclusion The pull technique appears to be associated with a significantly higher risk of infection compared with the introducer technique.