Early versus delayed feeding after push-technique percutaneous endoscopic gastrostomy: A randomized controlled trial

Abstract Background and Aims Traditional guidelines recommend delayed feeding after percutaneous endoscopic gastrostomy (PEG) because of concerns about postprocedural complications. Early feeding is safe after pull-technique PEG; however, optimal timing after push-technique PEG remains uncertain. We evaluated the safety and efficacy of early vs delayed feeding after push-technique PEG, focusing on maximal gastric residual volume, complications, and wound site bacterial colonization. Methods A randomized noninferiority trial was conducted at a university hospital in 160 patients undergoing successful push-technique PEG placement between February 2022 and June 2023. Patients were randomized 1:1 to early feeding (<4 hours) or delayed feeding (>12 hours). Both groups received identical intermittent drip-feeding protocols. The primary outcome was maximal gastric residual volume. Secondary outcomes were length of stay, opioid consumption, postprocedural complications, and wound culture. Results Median time to feeding was 2.2 hours (0.7–4.0) in the early group and 17.2 hours (12.8–40.5) in the delayed group. Maximal gastric residual volume did not differ between groups (0 vs 0 mL; P =0.26). Early feeding reduced hospital stay (42.3 vs 46.0 hours; P <0.01) and opioid use (2.0 [0–10] vs 2.0 [0–12] mg; P =0.01). Rates of complications (fever, bleeding, wound infection, abdominal distension) were comparable (20.0% vs 27.5%; P =0.35). Wound cultures showed no significant difference in bacterial colonization (26.3% vs 22.5%; P =0.58). Conclusions Early enteral feeding within 4 hours after push-technique PEG is safe, does not impair gastric emptying, and reduces hospital stay and opioid use. These findings extend the evidence for early feeding to push-technique procedures. Trial Registration Thai Clinical Trials Registry. Registration number TCTR20220105003. Web link: https://www.thaiclinicaltrials.org/show/TCTR20220105003 .