经口“拉”技术和直接“推”手术是经皮内镜胃造口术（PEG）放置的两种主要方法。尽管拉式 PEG 通常被推荐作为一线治疗方式，但许多肿瘤患者需要推式 PEG 方法来防止肿瘤种植或克服肿瘤相关的阻塞。我们的目的是比较两种 PEG 手术在癌症患者中的有效性和安全性。我们回顾性分析了三级肿瘤中心内所有连续的 PEG 手术。通过医院数据库和国家癌症登记处对患者进行随访，以评估 PEG 放置的技术成功率、轻微和主要不良事件 (AE) 的发生率以及 30 天死亡率。我们比较了两种 PEG 技术之间的结果。最后，使用多变量 Cox 比例风险回归模型分析 PEG 相关不良事件的危险因素，并根据患者的性别、年龄、体能状态 (ECOG)、体重指数 (BMI)、糖尿病、放化疗 (CRT) 状态进行调整。治疗前/当前/治疗后）以及 PEG 类型。我们纳入了 2014 年至 2021 年间对 994 名患者（平均年龄 62.0 [±10.7]）进行的 1055 例 PEG 手术（58.7% 推式 PEG/41.4% 拉式 PEG）岁；70.2% 男性；适应症：头颈癌 75.9%/其他癌症 24.1%）。 PEG 放置的总体技术成功率为 96.5%。尽管“推”技术的所有 AE 发生率较高（21.4% 比 7.1%，风险比 [HR] = 2.9；95% CI = 1.9-4.3，p < 0.001），但其中大多数构成轻微 AE（71.9） %)，例如管移位。这些方法在主要 AE 和 30 天死亡率方面没有显着差异。既往 CRT 与主要 AE 风险增加相关（风险比 = 2.7，95% CI = 1.0-7.2，p = 0.042）。癌症患者中推式 PEG 技术和拉式 PEG 技术的主要 AE 风险相当。由于推式 PEG 中管子频繁移位，拉式技术可能更适合长期喂养。以前的 CRT 会增加主要 AE 的风险，因此在预期进行此类治疗时有利于早期（“预防性”）PEG 放置。© 2023 作者。 《联合欧洲胃肠病学杂志》由 Wiley periodicals LLC 代表联合欧洲胃肠病学出版。

The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction.We aimed to compare the efficacy and safety of both PEG procedures in cancer patients.We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG.We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR]  = 2.9; 95% CI = 1.9-4.3, p < 0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio = 2.7, 95% CI = 1.0-7.2, p = 0.042).The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.© 2023 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.