Dwell time and functional failure in percutaneous endoscopic gastrostomy tubes: A prospective randomized-controlled comparison between silicon polymer and polyurethane percutaneous endoscopic gastrostomy tubes

Abstract

Background: Silicone percutaneous endoscopic gastrostomy (PEG) tubes are associated with more short-term complications and possibly fail sooner than those made of polyurethane. Understanding the deterioration and long-term complications leading to tube failure has important clinical and cost implications. Aim: To compare dwell time and patterns of failure of silicone polymer and polyurethane PEG tubes. Methods: Participants randomized to receive a silicone-polymer (n = 76) or polyurethane (n = 62) PEG were visited monthly for 540 days, until death or tube removal. Tube and exit site characteristics and reasons for removal were recorded. Results: Tube failure occurred in 25% of silicone PEGs and 12.9% of polyurethane PEGs. Mean tube survival for silicone PEGs was 377.2 days (CI: 326-428) and for polyurethane 436.8 days (CI: 383-490; P = 0.13). A greater proportion of silicone PEGs developed intralumenal colonization and altered tube integrity than polyurethane (P < 0.001), Silicone PEGs blocked more frequently (P < 0.005) and were removed because of irreversible blockage more often than polyurethane PEGs (P < 0.05), Silicone PEGs with reversible blockage and tube integrity changes had a significantly greater probability of failure than silicone tubes without these changes (P < 0.005 and P < 0.05, respectively). Conclusions: Observations over time indicate that silicone PEGs are more susceptible than polyurethane PEGs to tube deterioration, resulting in substantially increased management demands to sustain patients' feeding and medication schedules.