V.V. Lozovaya1, O.A. Malikhova1,2, A.O. Tumanyan1, O.A. Gusarova1

1N.N. Blokhin National Medical Research Center of Oncology, Moscow

2Russian Medical Academy of Continuous Professional Education, Moscow

Lozovaya Valeriya V. ― Endoscopist of the Endoscopy Department of the N.N. Trapeznikov Research Institute of Clinical Oncology, assistant of the Department of Postgraduate Education of Doctors of the N.N. Blokhin National Medical Research Center of Oncology

24 Kashirskoe Shosse, Moscow, 115478, Russian Federation, tel. +7-985-136-12-78, e-mail:, ORCID ID: 0000-0001-6262-7763


Background. Percutaneous endoscopic gastrostomy (PEG) is an effective and safe method of nutritional support in patients with a low body mass index and the inability to eat orally. The main indications for PEG include malignant neoplasms of the upper GIT, tumors of the head and neck, neuromotor dysfunction of the GIT. There are two methods for inserting an endoscopic gastrostomy, PUSH (push method) and PULL (pull method), which is the most widely used by endoscopists in their daily practice. Currently, there are no clinical studies in Russia aimed at comparing two different PEG methods and studying the correlation between the method and the risk of postoperative complications.

Aims ― to compare the incidence and development of complications in patients with cancer after PEG using PUSH- and PULL- methods.

Material and methods. In a retrospective study conducted on the basis of the Federal State Budgetary Institution «N.N. Blokhin National Medical Research Center of Oncology» of the Ministry of Health of Russia in the period from January to December 2022, the results of PEG were analyzed in 51 patients (100%) with malignant tumors of different localization. All patients at the first stage underwent diagnostic esophagogastroduodenoscopy (EGDS) to determine the possibility and the method of PEG. At the second stage, PEG was performed.

Results. The study group consisted of 51 patients (100%) of predominantly adult age (age >18 years) (N=39; 76,5%). The study included 45% of men (N=23) and 55% of women (N=28). The main indication for PEG in 55% of cases (N=28) was the development of dysphagia. Most often, the localization of the tumor corresponded to the head and neck (N=19; 37,3%) and esophagus (N=17; 33,3%). In 62,7% of cases (N=32) PEG was performed by the PULL method, in 37,3% (N=19) by the PUSH method. There was no significant correlation between the PEG method, the type of gastrostomy, and the nature of the development of complications in the postoperative period (p> 0,3), however, the incidence of complications was 4 times higher in patients with the PULL PEG method.

Conclusion. Despite the absence of a significant correlation between the method of performing PEG and the risk of complications, the PUSH method, in comparison with the PULL method, shows greater safety and can be recommended as more preferable in patients with malignant tumors, in particular, tumors of the head, neck and esophagus. The results obtained require further study in a larger group of patients.

Key words: PEG, percutaneous endoscopically-assisted puncture gastrostomy, PUSH method, PULL method, endoscopy, complications, head and neck tumors, esophageal cancer.