Percutaneous endoscopic gastrostomy for palliative oncology patients – a safety analysis in a retrospective cohort study

Background Patients with advanced cancer who are receiving palliative care represent a highly vulnerable population. The role of percutaneous endoscopic gastrostomy (PEG) in this setting is controversial, particularly when life expectancy is limited. Our study aimed to assess complication rates following PEG placement in palliative oncology patients, as well as to compare outcomes with a non-palliative cohort. This comparison was made to identify safety signals that might argue against PEG placement in this population. Additionally, we aimed to evaluate the safety profiles of different PEG techniques. Methods In this retrospective cohort study, we analyzed patients who underwent PEG placement at the three endoscopic units of Charité – Universitätsmedizin Berlin between 2016 and 2021. Of these patients, 146 had advanced malignancy and were receiving palliative care. These patients were compared with 1.423 patients who underwent PEG placement in a non-palliative setting. Univariate- and multivariate analyses were performed to evaluate peri- and post-interventional complications. We present mortality data with a focus on PEG-related mortality. Results Overall complication rates did not differ significantly between palliative and non-palliative patients (37.0% vs. 32.3%; p = 0.246), while procedure-related mortality was higher in the palliative cohort (2.1% vs. 0.4% p = 0.013), although the number of events was small. In an additional analysis restricted to oncological patients, palliative status was not significantly associated with overall, peri-interventional, minor or major complications in multivariable models adjusted for age, sex, BMI, PEG placement technique, and PEG indication. Conclusion PEG placement in patients with advanced cancer who are receiving palliative care is not associated with significantly higher peri- or post-interventional complications compared to patients who are not receiving palliative care. Decisions regarding PEG placement should be made on a case-by-case basis, taking into account the clinical indication, anticipated benefits, patient preferences and procedural risks.