Comparative Safety and Volume Trends in Gastrostomy Tube Placement: Percutaneous Endoscopic Versus Percutaneous Radiologic Approaches at a Single Center

Background: Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are established techniques for long-term enteral access. Contemporary comparisons of complication patterns, length of stay (LOS), and utilization trends remain limited. Methods: We conducted a retrospective cohort study of adult patients undergoing initial gastrostomy placement at a single academic center between 2021 and 2024 (n = 341). The primary outcome was any 30-day procedure-related complication. Secondary outcomes included complication subtypes, LOS, and procedural volume trends. Multivariable regression analyses were performed to adjust for potential confounders. Results: Among 341 patients, 195 underwent PEG and 146 PRG. Overall complication rates were similar (PEG 16.4% vs. PRG 14.4%, p = 0.31). Infectious complications were numerically higher with PEG (4.1% vs. 1.4%), though not statistically significant. Mean LOS was 3.2 days for PEG and 2.8 days for PRG (p = 0.12). On multivariable analysis, gastrostomy technique was not associated with complications (aOR 0.88, 95% CI 0.48–1.61) or LOS. PRG utilization increased substantially over the study period, comprising 60.7% of procedures by 2024. Conclusions: PEG and PRG demonstrated no statistically significant differences in safety outcomes, with no statistically significant differences in complications or LOS. A marked shift toward PRG utilization was observed over time. These findings support individualized, patient-centered selection of gastrostomy technique, while acknowledging limited power to detect small but clinically meaningful differences.