{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T03:39:17Z","timestamp":1792640357122,"version":"4.5.0"},"reference-count":22,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["UEG Journal"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The peroral \u201cpull\u201d technique and the direct \u201cpush\u201d procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull\u2010PEG is generally recommended as the first\u2010line modality, many oncological patients require a push\u2010PEG approach to prevent tumor seeding or overcome tumor\u2010related obstruction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We aimed to compare the efficacy and safety of both PEG procedures in cancer patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30\u2010day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG\u2010related adverse events were analyzed using a multivariable Cox proportional\u2010hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre\u2010\/current\u2010\/post\u2010treatment), and type of PEG.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 1055 PEG procedures (58.7% push\u2010PEG\/41.4% pull\u2010PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [\u00b110.7] yrs.; 70.2% males; indication: head\u2010and\u2010neck cancer 75.9%\/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the \u201cpush\u201d technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] \u00a0=\u00a02.9; 95% CI\u00a0=\u00a01.9\u20134.3, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30\u2010day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio\u00a0=\u00a02.7, 95% CI\u00a0=\u00a01.0\u20137.2, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.042).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The risk of major AEs was comparable between the push\u2010 and pull\u2010PEG techniques in cancer patients. Due to frequent tube dislodgement in push\u2010PEG, the pull technique may be more suitable for long\u2010term feeding. Previous CRT increases the risk of major AEs, favoring early (\u201cprophylactic\u201d) PEG placement when such treatment is expected.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ueg2.12467","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T16:49:24Z","timestamp":1699634964000},"page":"951-959","source":"Crossref","is-referenced-by-count":5,"title":["To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0664-159X","authenticated-orcid":false,"given":"Piotr","family":"Kucha","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Clinical Oncology Center of Postgraduate Medical Education  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Zorniak","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Clinical Oncology Center of Postgraduate Medical Education  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mateusz","family":"Szmit","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Clinical Oncology Center of Postgraduate Medical Education  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafal","family":"Lipczynski","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Clinical Oncology Center of Postgraduate Medical Education  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulina","family":"Wieszczy\u2010Szczepanik","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Clinical Oncology Center of Postgraduate Medical Education  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleksandra","family":"Kapala","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition Maria Sklodowska\u2010Curie National Research Institute of Oncology  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urszula","family":"Wojciechowska","sequence":"additional","affiliation":[{"name":"Polish National Cancer Registry Maria Sklodowska\u2010Curie National Research Institute of Oncology  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna","family":"Didkowska","sequence":"additional","affiliation":[{"name":"Polish National Cancer Registry Maria Sklodowska\u2010Curie National Research Institute of Oncology  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maciej","family":"Rupinski","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Clinical Oncology Center of Postgraduate Medical Education  Warsaw Poland"},{"name":"Department of Oncological Gastroenterology Maria Sklodowska\u2010Curie National Research Institute of Oncology  Warsaw Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Olesinski","sequence":"additional","affiliation":[{"name":"Department of Oncological Gastroenterology Maria Sklodowska\u2010Curie National Research Institute of Oncology  Warsaw 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