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Aim and background: Percutaneous endoscopic gastrostomy (PEG) placement is safe and expeditious, yet the procedure is not entirely risk free. Large series reported procedure related mortality of 1-3%, with major complications in 3-9% and minor complications in up to 30% of cases. Previous studies reported no difference between PEG techniques, but most of them did not describe gastrostomy tube diameter. This study aims to compare push and pull technique of PEG placement with a follow−up period of 90 days, using the same gastrostomy tube diameter, 20Fr. Methods: Patients over 18 years were randomized to either the push or pull technique by block computerized randomization. This was a single center prospective controlled trial. Prophylactic antibiotic was prescribed, and the success rate, duration, as well as major and minor complications of both procedures were evaluated. Patients were evaluated at the 7th and 21th day, as well as 3 months after PEG placement. Differences were considered significant if P< 0.05. Results: A total of 40 patients were enrolled, with 20 assigned to each technique. The gastropexy method (push) tended to require more time (11.1 + 4.8 vs. 6.8 + 2.3 minutes, NS), and was associated with more complications. Complication was achieved by relative risk calculation for age (P=0.031), endoscopy duration (P=0.022), and gastropexy method (P=0.047), as factors associated with unfavorable course. Conclusions: Despite similar success rate, complications were not identical. Choice of the method belongs to the endoscopist, in the light of personal expertise and device availability. *Correspondence to: Iatagan Rocha Josino. MD, Division of Gastrointestinal Endoscopy, Faculdade de Medicina da Universidade de São Paulo, Carvalho Aguiar street, number 255, 6th floor, São Paulo SP 05422-090, Brazil, Tel: 551126616221, E-mail: Iatagan.josino@gmail.com

A comparative randomized trial with 20 Fr pulls and 20 Fr push technique for percutaneous endoscopic gastrostomy using a new device