# Intragastric Localization as a Determinant of Peg Complications: A Comparative Analysis of Proximal and Distal Placements

## TL;DR

This study shows that placing PEG tubes in the distal stomach increases complication risks compared to proximal placement, suggesting safer practices for patients.

## Contribution

The study identifies intragastric localization as a novel determinant of PEG complications.

## Key findings

- Distal PEG placement had a 30.6% complication rate, significantly higher than the 14.1% for proximal placement.
- Both early and late complications were more frequent in the distal group.
- Low BMI and male patients had significantly higher complication rates.

## Abstract

Background and Objectives: While percutaneous endoscopic gastrostomy (PEG) is a standard procedure for long-term enteral nutrition, the impact of precise intragastric tube localization on complications remains underexplored. This study aimed to determine whether proximal versus distal placement is a significant determinant of PEG-related complications and to identify associated risk factors. Materials and Methods: This retrospective study evaluated the medical records of 268 adult patients who underwent PEG for the first time at a single center between June 2022 and January 2025. Patients were divided into two groups based on the intragastric position of the PEG tube: Group A (proximal placement) and Group B (distal placement), defined anatomically in relation to the incisura angularis. The complication rate was 30.6% in patients with distally placed PEG tubes, compared to 14.1% in those with proximal placement. Demographic characteristics, PEG indications, body mass index (BMI), comorbidities, and anticoagulant use were recorded. Complications were classified as early (≤7 days) or late (8 days–6 months), and by severity as minor or major. Results: The complication rate was 30.6% in patients with distally placed PEG tubes, compared to 14.1% in those with proximal placement (p = 0.004), corresponding to an odds ratio of 2.7 (95% CI: 1.4–5.2). Both early and late complications, as well as minor and major events, were more frequently observed in the distal group. Patients with a low BMI and male patients demonstrated significantly higher co mplication rates (p = 0.0001 and p = 0.003). Five patients (1.8%) died due to PEG-related complications. Conclusions: PEG tubes positioned in the distal stomach carry a significantly higher risk of complications compared to proximal placement. These findings suggest that proximal intragastric positioning should be prioritized whenever feasible during PEG insertion to improve patient safety.