BACKGROUND:The burden of inflammatory bowel disease (IBD) is increasing rapidly across Asia, yet country-level evidence by subtype, age, and sex remains limited. Thus, we aimed to investigate long-term burdens and regional disparities in IBD burden across 34 Asian countries. METHODS:Using the Global Burden of Disease Study (GBD) 2023 estimates, we assessed the burden of IBD, including ulcerative colitis (UC) and Crohn's disease (CD), across 34 countries in five Asian regions, from 1990 to 2023. IBD was defined using International Classification of Diseases, Tenth Revision (ICD-10) codes K50 for CD, K51 for UC, and K52 for indeterminate colitis to define IBD-related cases. Age-standardized disability-adjusted life year rates (ASDRs) and age-standardized prevalence rates (ASPRs) were estimated with 95% uncertainty intervals (UIs), and temporal trends were evaluated using joinpoint regression, average annual percentage changes (AAPCs), and period-specific β coefficients for pre- and post-COVID-19 trends. The Das Gupta decomposition analysis was used to quantify the contributions of population growth, population aging, and epidemiological change to changes in disability-adjusted life-years (DALYs) and prevalence. RESULTS:From 1990 to 2023, ASPRs increased, whereas ASDRs declined for overall IBD, UC, and CD across the five Asian regions, although the magnitude varied by subregion. In 2023, Central Asia had the highest regional ASDR for overall IBD (17.08 [95% UI, 14.21-20.20] per 100,000 population), whereas Bangladesh had the highest national ASDR (24.58 [15.26-33.84]) and the highest UC ASDR. South Asia had the highest regional ASPR (48.83 [41.42-57.55]), whereas the Republic of Korea had the highest national ASPR (57.70 [49.62-67.05]) and the highest CD ASPR. AAPC analyses showed positive ASPR trends and negative ASDR trends across all five regions, with Mauritius and Thailand as the only countries showing increasing ASDR AAPCs. DALY rates increased sharply at older ages and were generally higher in males, but females had higher DALY rates at ages 95 years and older in East Asia and Southeast Asia. Decomposition analysis showed that DALYs and prevalence increased across all five subregions, with population growth and aging contributing positively and epidemiological effects generally contributing negatively to DALYs; Mauritius and Thailand were notable exceptions with positive epidemiological contributions to DALY increases. CONCLUSION:Marked heterogeneity and a rising IBD burden across Asia underscore an urgent public health challenge. Subtype-specific surveillance, earlier diagnosis, and long-term care strategies should be tailored to national burden patterns and health-system capacity.
BACKGROUND:Knowledge about clinical implications of non-spontaneous bacterial peritonitis (non-SBP) cirrhotic patients defined by ascitic fluid PMN (A-PMN) counts <250 cells/μL is limited. The aim of this study was to determine the development of SBP in non-SBP cirrhotic patients with high A-PMN counts and compare it with low A-PMN count. METHODS:In this prospective observational study, cirrhotic patients with ascites were stratified into three categories based on A-PMN counts: 1) SBP group (PMN ≥250 cells/μL, n = 25), 2) Intermediate A-PMN group (I-PMN) (PMN counts: 60-249 cells/μL, n = 50), and 3) Low A-PMN group (L-PMN) (PMN counts ≤60 cells/μL, n = 81). All patients were followed periodically up to 6 months for development of SBP. RESULTS:All the demographic profiles of patients including CTP and MELD-Na scores were similar among all the three groups. Eleven patients (44%) in SBP and five patients (10%) in the I-PMN group developed SBP, whereas none of the patients in the L-PMN group developed SBP ( P < 0.001). A-PMN counts ( P = 0.02) were found to be significantly correlated with follow-up development of SBP. APMN counts ≥171 cells/μL predicted the development of SBP with 87.5% sensitivity and 87.9% specificity. The 6 months mortalities in I-PMN and L-PMN groups were comparable. The rehospitalization rate in I-PMN is significantly higher than that in L-PMN. CONCLUSION:Patients of the I-PMN group are associated with a significantly higher rate of development of SBP at month 6 as compared to the L-PMN group.
Abstract Early engagement in research is fundamental to the advancement of gastroenterology as both a clinical and scientific discipline. Despite growing interest among trainees, many early-career gastroenterologists face substantial structural barriers: limited mentorship, insufficient methodological training, inadequate protected time, and competing clinical demands. This Special Communication presents a practical framework integrating an individual roadmap for research development with a society-led mentorship ecosystem. We outline strategies to cultivate a research mindset, develop foundational competencies, and generate meaningful academic impact—operationally defined across scholarly output, collaborative contribution, translational influence, and training pipeline dimensions. The role of professional societies in building structured mentorship pathways and collaborative networks is discussed with reference to the European Crohn’s and Colitis Organization (ECCO) Y-ECCO and American Gastroenterological Association (AGA) FORWARD programmes. The evolving Saudi research landscape, including Vision 2030 priorities, Saudi Commission for Health Specialties (SCFHS) fellowship requirements, King Abdullah International Medical Research Center (KAIMRC), and King Abdulaziz City for Science and Technology (KACST) funding opportunities, is contextualized. Paired reflective accounts from a senior and an early-career gastroenterologist illustrate the practical realities of building a sustainable research career. Together, these perspectives and the accompanying operational framework provide a pragmatic, regionally anchored roadmap for nurturing the next generation of gastroenterology researchers.
BACKGROUND:Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), carries substantial physical and psychosocial burdens. Illness-related stigma may adversely affect quality of life (QoL), while perceived social support may be associated with these relationships. However, evidence from Saudi Arabia remains limited. This study examined the associations among stigma management strategies, perceived social support, and QoL among adults with IBD in Saudi Arabia. METHODS:A cross-sectional study was conducted among 103 adults with a self-reported gastroenterologist diagnosis of CD or UC. Participants were recruited using convenience and snowball sampling through online patient support groups, healthcare networks, and WhatsApp groups. Data were collected using an adapted Stigma Management Strategies Scale, the Multidimensional Scale of Perceived Social Support, and the WHOQOL-BREF. Group comparisons and bootstrap analyses of indirect associations were performed. RESULTS:Education/advocacy was the most frequently reported stigma management strategy, whereas withdrawal was the least common. Family was the highest perceived source of social support. Bootstrap analyses identified significant indirect associations involving perceived social support between secrecy, withdrawal, and poorer QoL, whereas education/advocacy showed positive indirect associations with QoL. Preventive telling showed no significant indirect associations. Participants with UC reported significantly higher social relationships and overall QoL scores than those with CD. CONCLUSION:Adaptive stigma management strategies and greater perceived social support were associated with better QoL among adults with IBD in Saudi Arabia, whereas concealment-based strategies were associated with poorer QoL. Longitudinal studies incorporating disease activity and other clinical factors are needed to confirm these findings.
ABSTRACT:Adequate nutritional support is a critical component of patient management, particularly for individuals who are unable to sustain oral intake due to neurological, structural, or functional impairments. Percutaneous endoscopic gastrostomy (PEG) has become the preferred modality for long-term enteral access, offering a minimally invasive technique with high success rates and favorable safety outcomes. Common indications include cerebrovascular accidents, neurodegenerative disorders, dementia, cerebral palsy, head and neck malignancies, and severe dysphagia of various etiologies. This review summarizes the key clinical considerations surrounding PEG placement, including patient selection, contraindications, and preprocedural evaluation. We describe the principles of PEG insertion techniques and provide an evidence-based comparison between endoscopic, radiologic, and surgical gastrostomy methods, focusing on differences in complication rates, procedure-related morbidity, and patient suitability. Early and late complications of PEG placement are discussed in detail, with emphasis on preventive measures, timely recognition, and optimal management strategies. Additionally, we outline essential components of postprocedural care, routine monitoring, and recommended follow-up to ensure long-term tube function and patient safety.
Abstract International fellowship training has become an increasingly important component of career development for gastroenterologists worldwide. Beyond clinical training, overseas fellowships provide opportunities for exposure to different healthcare systems, multidisciplinary models of care, research environments, leadership structures, and academic networks. For trainees from Saudi Arabia and the Gulf region, international fellowships may facilitate professional growth, academic development, and the establishment of long-term collaborative relationships.
BACKGROUND:During follow-up of IPMN, attention should be paid to both IPMN-derived carcinoma and PDAC concomitant with IPMN (concomitant PDAC). Concomitant PDAC lacks clear risk factors and is often detected late. This study evaluated non-contrast MRI performance for early detection and identification of optimal imaging sequences. METHODS:Patients histologically diagnosed with PDAC between May 2012 and March 2024 who underwent MRI at diagnosis were retrospectively included. PDAC located ≥5 mm from an IPMN was defined as concomitant PDAC. Cases of IPMC and main-duct IPMN were excluded. MRI sequences (T1WI, T2WI, MRCP, and DWI with ADC maps) were reviewed. Tumor detection was defined as (1) mass identification on T1WI/T2WI, (2) Main pancreatic duct (MPD) stricture or poor visualization with upstream dilatation on MRCP, or (3) hyperintense mass on DWI. Two radiologists independently evaluated all images. RESULTS:Sixty-four cases (28 females; median tumor diameter, 21 mm) were analyzed. The median age at diagnosis was 74.5 years (interquartile range: 68-80 years), Blood test values showed median CA19-9 levels of 78 U/mL. The detection sensitivities by radiologists A and B were T1WI, 76.7%/68.3% (κ0.71); T2WI, 31.3%/29.7% (κ0.71); DWI, 71.4%/71.4% (κ0.87); and MRCP, 43.4%/35.8% (κ0.84). Combined sensitivities were 89.1%/82.8% for "T1WI and DWI" and 92.2%/85.9% for "T1WI, DWI and MRCP". CONCLUSIONS:Among single sequences, T1WI demonstrated the highest sensitivity. The combination of "T1WI, DWI, and MRCP" showed the highest sensitivity, although the differences were not statistically significant and should be interpreted cautiously for detecting PDAC concomitant with IPMN.
ABSTRACT:Metabolic dysfunction-associated steatotic liver disease (MASLD) is highly prevalent in the Middle East and North Africa (MENA) region, yet published estimates of prevalence and outcomes remain uncertain because the underlying denominators are inconsistently defined. This perspective argues that MENA MASLD epidemiology is systematically biased by three interacting mechanisms: distorted sampling frames, referral pathway selection, and structural undercapture of rural and displaced populations. Much of the current evidence is derived from convenience cohorts concentrated in urban, tertiary care settings where diagnostic availability and follow-up are greater than in the general population, leading to directional rather than random error. In parallel, risk stratification pathways that rely on two-step testing can funnel case detection toward specialty rich settings, overrepresenting advanced disease while missing earlier stages managed outside hepatology services. MASLD nomenclature change and incomplete alignment of coding and clinical documentation may further introduce artefactual inflection points that complicate trend interpretation. We highlight how underdiagnosis and under-recording in primary care propagate bias across downstream estimates and how validation of administrative algorithms and text-based ascertainment can quantify hidden disease reservoirs within routine data systems. Building on regional priority settings, we propose denominator-focused actions: probability-based sampling embedded in noncommunicable disease surveys; purposeful inclusion of rural and displaced groups; linkable data across primary care, laboratories, hospitals, and mortality registries; and harmonized coding and terminology. By decision-grade denominators, we refer to population denominators that are sufficiently representative, transparent, and linkable to support national surveillance, resource allocation, and trial-readiness decisions.
BACKGROUND:Although overall colorectal cancer (CRC) incidence has stabilized or declined in some regions, early-onset CRC (EO-CRC) is increasing in many countries. We aimed to compare EO-CRC with average-onset CRC (AO-CRC) to inform screening and care policies in Saudi Arabia. METHODS:This retrospective study included patients with newly diagnosed CRC from, January 2017 to December 2023, at two referral centers in Saudi Arabia. We compared patient and tumor characteristics between EO-CRC and AO-CRC. Kaplan-Meier curve with log-rank test was used to compare overall survival up to 36 months after diagnosis. RESULTS:Of 1365 patients with confirmed CRC, 406 (29.7%) had EO-CRC and 959 (70.3%) had AO-CRC, with more males in both groups (56% in EO-CRC and 53% in AO-CRC; P = 0.373). Hypertension and type 2 diabetes were more common in AO-CRC (both P < 0.001), while smoking history was more frequently documented in EO-CRC (16.7% vs. 12.0%; P = 0.054), although this difference did not reach statistical significance. Late-stage diagnosis was more frequent in EO-CRC (stage IV: 53.0% vs. 42.3%; P = 0.009), while tumor location was similar across groups, predominantly left-sided (87% vs. 89%; P = 0.391). Symptom profiles were broadly comparable between groups. Abdominal pain was more common in EO-CRC (60.3% vs. 53.6%; P = 0.015), whereas rectal bleeding occurred at similar frequencies in both groups (45.3% vs. 46.7%; P = 0.860). At 36 months, estimated survival probabilities were 0.75 for EO-CRC and 0.78 for AO-CRC, with no significant difference between groups on unadjusted analysis (log-rank P = 0.40). In multivariable Cox regression adjusting for sex and stage, EO-CRC was not associated with a difference in hazard of death than AO-CRC (adjusted hazard ratio 1.04, 95% confidence interval 0.80-1.37). CONCLUSION:EO-CRC comprised approximately one-third of CRC diagnoses in our cohort. Patients with EO-CRC had higher rates of late-stage diagnosis and more commonly presented with abdominal pain, whereas rectal bleeding, a well-recognized alarm symptom, occurred at similar frequencies in both groups. Despite later-stage presentation, short-term survival up to 36 months was similar between EO-CRC and AO-CRC. These findings highlight the need for tailored screening and early detection in younger populations.
BACKGROUND:First-degree relatives (FDRs) of colorectal cancer (CRC) patients are at increased risk for CRC. Colonoscopy is the recommended screening modality, yet uptake in this high-risk group remains poorly characterized, particularly in Saudi Arabia. METHODS:We conducted a cross-sectional study of FDR of patients diagnosed with CRC at a tertiary academic center. They completed a structured questionnaire assessing awareness of CRC screening, previous screening practice, and perceived barriers to undergoing a colonoscopy. RESULTS:Among 346 FDRs, 122 (35.3%) were aware of CRC screening recommendations and 78 (22.5%) had undergone colonoscopy. Among participants who had not undergone colonoscopy and provided complete barrier-response data ( n = 268), the most commonly reported barrier was lack of information or inadequate counseling (51.9%, n = 139), followed by psychological fear (17.9%, n = 48) and financial barriers (16.4%, n = 44). Colonoscopy uptake did not differ by gender (23.4% vs. 19.7%, P = 0.423) but was higher among those with higher educational attainment and medical backgrounds ( P = 0.001). CONCLUSION:CRC screening awareness and colonoscopy uptake among FDRs of CRC patients are suboptimal. Family-centered counseling at diagnosis, structured patient navigation, and tailored education programs are needed to improve screening participation in this at-risk population.
BACKGROUND:Data on STRIDE-II treatment target achievement in Middle Eastern inflammatory bowel disease (IBD) populations remain limited. We assessed the prevalence and predictors of deep remission at a tertiary IBD center in the United Arab Emirates. METHODS:A cross-sectional analysis was conducted on 389 IBD patients (242 Crohn's disease [CD], 147 ulcerative colitis [UC]) on stable treatment for ≥6 months. Deep remission required concurrent clinical, biochemical, and endoscopic remission. Predictors were identified using logistic regression. RESULTS:Complete STRIDE-II assessment was available in 264 patients (67.9%). Deep remission was achieved in 164 patients (62.1% available-case; 42.2% conservative, treating incomplete assessments as failure). In the advanced therapy subgroup ( n = 182), deep remission was 64.3% available-case and 43.8% conservative. Clinical remission was 78.7%, biochemical remission 72.4%, and endoscopic remission 69.2%. Rates were similar between CD and UC, and complicated CD phenotypes achieved equivalent deep remission to non-complicated disease (62.7% vs 63.9%, P = 0.85). Disease duration was the strongest overall predictor (OR 1.06 per year, 95% CI 1.02-1.10, P = 0.009). CD-specific predictors included B3 penetrating behavior (OR 5.49, P = 0.027) and male sex (OR 0.47, P = 0.039). In UC, older age and male sex were independently associated with remission. Higher advanced therapy exposure predicted lower remission odds in CD (adjusted OR 0.70, P = 0.034). No individual therapy demonstrated significant superiority in adjusted drug comparisons. Efficacy was preserved at second-line (67.4%) with decline at third-line (50.0%). CONCLUSION:Deep remission rates in this UAE tertiary center cohort were comparable to or numerically higher than international reports. Further validation in prospective, geographically diverse populations is warranted.
BACKGROUND:Abnormal liver function tests (LFTs) are common in inflammatory bowel disease (IBD), yet data from the Middle East are lacking. We aimed to determine the prevalence, etiological spectrum, and risk factors for abnormal LFTs in a tertiary IBD cohort in the United Arab Emirates. METHODS:In this retrospective cohort study with cross-sectional and longitudinal components, all adult IBD patients in a tertiary institutional registry were screened for abnormal LFTs. Etiologies were assigned across predefined categories, and logistic regression identified associated factors. RESULTS:Persistent abnormal LFTs (per the operational definition) were identified in 72 of 510 patients (14.1%, 95% CI 11.4-17.4%). The most common etiology was metabolic dysfunction-associated steatotic liver disease (MASLD, 22.2%), followed by infection-related causes (11.1%), drug-induced liver injury (11.1%), and IBD activity-related causes (4.2%). Viral hepatitis screening was performed in ≥86% of cases; autoimmune markers were tested in 36-56%, and FibroScan in 24%. After adjustment for concomitant primary sclerosing cholangitis (PSC-IBD) as a clinically important confounder, cumulative advanced therapy exposure remained associated with abnormal LFTs (adjusted OR 1.20, 95% CI 1.00-1.42, P = 0.041); PSC-IBD itself was strongly associated with abnormal LFTs in the model (adjusted OR 8.69, 95% CI 3.11-25.24, P < 0.001), as expected. LFTs normalized in 30.0% and improved in 20.0% of patients during follow-up. CONCLUSIONS:Abnormal LFTs affected one in seven IBD patients in this UAE cohort, with MASLD as the leading cause. These findings suggest potential value in integrating structured liver investigation algorithms into routine IBD care.
BACKGROUND:Inflammatory bowel disease (IBD) is a chronic inflammatory disorder affecting the gastrointestinal tract. Optimal management of this condition requires collaboration between patients and physicians, a process known as shared decision-making (SDM). In this study, we aim to evaluate the quality of SDM in gastroenterology clinics in the Eastern Province of Saudi Arabia. METHODS:This multicenter, cross-sectional study was conducted between September 2024 and December 2025. Audio recordings of gastroenterology visits were independently assessed by two reviewers using the validated Observing Patient Involvement in Decision-Making (OPTION-5) scale. Moreover, patients evaluated their encounters using the 9-item SDM Questionnaire (SDM-Q-9). A multivariable regression analysis was performed to determine independent predictors of SDM from both the patient and physician perspectives. RESULTS:A total of 105 encounters from three hospitals were analyzed with a median OPTION-5 score of 5 out of 100 (IQR 0-10). A multivariate linear regression analysis showed that longer consultation duration in minutes ( β = 1.88, 95% Confidence Interval (CI): 0.21-3.56, P = 0.028) and the decision to start a new medication ( β = 24.86, 95% CI: 17.24-32.48, P < 0.001) were independently associated with higher total OPTION-5 scores. There was no significant correlation between observer-rated OPTION-5 scores and patient-reported SDM-Q-9 scores (Spearman's ρ = -0.044, P = 0.687), indicating discordance between externally assessed and patient-perceived shared decision-making. CONCLUSION:In this cohort of patients with IBD from three centers in the Eastern Province of Saudi Arabia, observer-rated SDM was low. Multiple factors were significantly associated with the level of SDM, including longer consultation duration and decision to start new medication. Further studies to determine interventions that can enhance SDM are warranted.
Background:Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, though the optimal distance from the pylorus for gastric transection remains debated. Differences in antral size may influence postoperative symptoms, complications, and weight outcomes, yet comparative evidence remains limited. This study compares LSG with antrectomy versus antrum preservation using real-world data from a high-volume center.Methods:A retrospective review of 157 patients who underwent primary LSG between 2019 and 2023 was conducted. Patients were categorized into antrum resection and antrum preservation groups based on standardized surgeon techniques. Outcomes included weight change, metabolic markers, complications, and patient-reported symptoms documented through structured EMR fields. Multivariable regression analyses were conducted after adjusting for age, sex, and surgeon.Results:Both groups achieved significant reductions in BMI and weight over 18 months, with no statistically significant differences at any follow-up time point (3-month P = 0.366, 6-month P = 0.932, 12-month P = 0.924, 18-month P = 0.445). Percentage total weight loss (%TWL) was comparable between groups at 1 year (34.3% vs. 30.6%, P = 0.088) and 18 months (40.6% vs. 31.8%, P = 0.076). Postoperative complications were significantly higher in the antrectomy group (9.6% vs. 1.4%, P = 0.036). Nausea was more frequently reported in the antrum-preserving group, while psychological symptoms, particularly feelings of failure, were more common following antrectomy.Conclusion:Both surgical techniques produced similar medium-term weight loss and metabolic outcomes. Antrum preservation demonstrated a more favorable safety profile and fewer negative psychological symptoms, whereas antrectomy was associated with increased complications. Larger prospective studies are required to determine long-term clinical and quality-of-life implications.
ABSTRACT:Fatigue is among the most prevalent and disabling symptoms in inflammatory bowel disease (IBD), affecting a substantial proportion of patients during active disease and persisting in many despite clinical remission. It is multidimensional, spanning physical, cognitive, and emotional domains, and it is a major determinant of health-related quality of life, work disability, and healthcare use. Correlations with conventional markers of intestinal inflammation are typically modest, indicating important contributions from extraintestinal, neuroimmune, nutritional, endocrine, sleep-related, and psychological mechanisms. This article is a narrative review with a structured literature synthesis, rather than a formal scoping review. The core search covered MEDLINE/PubMed, Embase, and the Cochrane Library from January 2010 to October 31, 2024, with targeted citation updates added during revision for recently finalized publications. Compared with recent broad reviews, the present manuscript adds three specific elements: explicit differentiation of evidence derived from primary randomized trials, prespecified patient-reported outcome analyses, and post hoc fatigue analyses; an updated synthesis of fatigue data for newer advanced therapies, particularly IL-23 and JAK-pathway agents; and a pragmatic biopsychosocial assessment-and-management framework with specific discussion of Arabic-language patient-reported outcome implementation and Middle East/North Africa practice considerations. Available evidence supports a stepwise clinical approach: First assess inflammatory activity and disease control; then screen systematically for reversible contributors including iron deficiency, other micronutrient deficits, endocrine abnormalities, sleep disorders, pain, mood disturbance, sarcopenia, and deconditioning. Validated instruments such as the Inflammatory Bowel Disease-Fatigue (IBD-F) questionnaire and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale are useful for serial monitoring. A clinically meaningful FACIT-Fatigue improvement appears to be context-specific; across IBD studies, approximately 6-10 points have the strongest empirical support, while trial-specific thresholds should be reported as originally prespecified. Biologic and targeted synthetic therapies can improve fatigue, but fatigue has rarely been a primary endpoint in pivotal trials. Anti-tumor necrosis factor agents, vedolizumab, ustekinumab, JAK inhibitors, and IL-23 inhibitors have all shown beneficial effects on fatigue-related outcomes, although the evidentiary strength varies from primary trial data to exploratory post hoc analyses. Nonpharmacological strategies including intravenous iron when indicated, exercise and rehabilitation, optimization of sleep and pain, and cognitive-behavioral or mindfulness-based interventions remain essential. Fatigue should therefore be recognized as a core manifestation of IBD and incorporated into routine patient-reported outcome assessment and treat-to-target discussions.
BACKGROUND:Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are established routes for long-term enteral nutrition. Comparative studies commonly emphasize technical success and complications, while downstream care intensity and caregiver burden are less well quantified. METHODS:We conducted a retrospective comparative cohort study of patients who underwent PEG versus PRG at three tertiary care centers, between January 2021 and January 2025. Propensity score matching (1:1) was used to reduce selection bias, and the primary comparative analyses were performed in the matched cohort. Outcomes included technical success, procedure duration, 30-day complications, nutritional recovery, tube-care nursing interventions within 30 days, caregiver burden (Zarit Burden Interview, ZBI), and caregiver satisfaction (5-point Likert scale). RESULTS:After matching, 84 patients (42 per group) were analyzed. Technical success was comparable (PEG 98.7% vs. PRG 95.2%, P = 0.341), while procedure duration was shorter with PRG (22.1 ± 5.8 vs. 28.4 ± 6.5 min, P < 0.001). Thirty-day complications (16.7% vs. 21.4%, P = 0.541) and nutritional recovery (albumin at 1 month: 3.4 ± 0.4 vs. 3.3 ± 0.5 g/dL, P = 0.472; 4-week weight gain: 1.9 kg [1.0-2.7] vs. 1.8 kg [1.2-2.5], P = 0.715) were similar. PRG required more nursing interventions (6.1 ± 2.0 vs. 4.2 ± 1.3, P < 0.001). Caregiver burden was lower with PEG (ZBI 21.6 ± 5.2 vs. 26.4 ± 6.8, P = 0.002), and satisfaction scores were higher (mean ± standard deviation: 4.2 ± 0.9 vs. 3.4 ± 1.1, P = 0.001). CONCLUSION:PEG and PRG are both effective options for long-term enteral nutrition. Although PRG offers shorter procedure duration, PEG is associated with lower postprocedure care intensity and better caregiver-reported outcomes. Findings for complication rates are exploratory and hypothesis-generating and require confirmation in larger prospective studies.
