{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T22:18:05Z","timestamp":1768861085313,"version":"3.49.0"},"reference-count":15,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T00:00:00Z","timestamp":1768608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: While percutaneous endoscopic gastrostomy (PEG) is a standard procedure for long-term enteral nutrition, the impact of precise intragastric tube localization on complications remains underexplored. This study aimed to determine whether proximal versus distal placement is a significant determinant of PEG-related complications and to identify associated risk factors. Materials and Methods: This retrospective study evaluated the medical records of 268 adult patients who underwent PEG for the first time at a single center between June 2022 and January 2025. Patients were divided into two groups based on the intragastric position of the PEG tube: Group A (proximal placement) and Group B (distal placement), defined anatomically in relation to the incisura angularis. The complication rate was 30.6% in patients with distally placed PEG tubes, compared to 14.1% in those with proximal placement. Demographic characteristics, PEG indications, body mass index (BMI), comorbidities, and anticoagulant use were recorded. Complications were classified as early (\u22647 days) or late (8 days\u20136 months), and by severity as minor or major. Results: The complication rate was 30.6% in patients with distally placed PEG tubes, compared to 14.1% in those with proximal placement (p = 0.004), corresponding to an odds ratio of 2.7 (95% CI: 1.4\u20135.2). Both early and late complications, as well as minor and major events, were more frequently observed in the distal group. Patients with a low BMI and male patients demonstrated significantly higher co mplication rates (p = 0.0001 and p = 0.003). Five patients (1.8%) died due to PEG-related complications. Conclusions: PEG tubes positioned in the distal stomach carry a significantly higher risk of complications compared to proximal placement. These findings suggest that proximal intragastric positioning should be prioritized whenever feasible during PEG insertion to improve patient safety.<\/jats:p>","DOI":"10.3390\/medicina62010196","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T08:23:56Z","timestamp":1768811036000},"page":"196","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intragastric Localization as a Determinant of Peg Complications: A Comparative Analysis of Proximal and Distal Placements"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1979-2426","authenticated-orcid":false,"given":"Suat","family":"Evirgen","sequence":"first","affiliation":[{"name":"Department of General Surgery, Medical Faculty, Amasya University, Amasya 05100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9878-2554","authenticated-orcid":false,"given":"\u015eirin","family":"\u00c7etin","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Faculty of Medicine, Amasya University, Amasya 05100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8086-0956","authenticated-orcid":false,"given":"\u015eencan","family":"Acar","sequence":"additional","affiliation":[{"name":"Istanbul Florence Nightingale Hospital, Istanbul 34381, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5477-9492","authenticated-orcid":false,"given":"Abdurrahman","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Faculty of Medicine, Tokat Gaziosmanpasa University, Tokat 60030, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8234-6739","authenticated-orcid":false,"given":"Yavuz","family":"Pirhan","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Private Kolmed Hospital, Amasya 05100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hakan","family":"Sivgin","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Gaziosmanpasa University Faculty of Medicine, Tokat 60100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meryem","family":"\u00c7etin","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Faculty of Medicine, Amasya University, Amasya 05100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e000628","DOI":"10.1136\/bmjgast-2021-000628","article-title":"Prevention and management of major complications in percutaneous endoscopic gastrostomy","volume":"8","author":"Boeykens","year":"2021","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"144","DOI":"10.4274\/ejgg.galenos.2023.2023-2-2","article-title":"Comparison Between Geriatric and Non-geriatric Patients in the Development of Complications After Percutaneous Endoscopic Gastrostomy","volume":"5","author":"Karabacak","year":"2023","journal-title":"Eur. 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