TY - JOUR
T1 - A Systematic Review and Meta-Analysis on Outcomes and Complications of Percutaneous Endoscopic Versus Radiologic Gastrostomy for Enteral Feeding
AU - Strijbos, Denise
AU - Keszthelyi, Daniel
AU - Bogie, Roel M. M.
AU - Gilissen, Lennard P. L.
AU - Lacko, Martin
AU - Hoeijmakers, Janneke G. J.
AU - van der Leij, Christiaan
AU - de Ridder, Rogier
AU - de Haan, Michiel W.
AU - Masclee, Ad A. M.
PY - 2018/10
Y1 - 2018/10
N2 - Background:The optimal technique for long-term enteral feeding has not yet been established. Both percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are widely used. Aim was to extensively review outcomes of PEG and PRG.Materials and Methods:A systematic review using Medline, Embase, and Cochrane was performed, using standardized tools for assessing bias. Main outcomes were infectious and tube-related complications, procedure related and 30-day mortality. Pooled risk differences (RDs) with corresponding 95% confidence intervals (95% CIs) were calculated using random effects. Arcsine transformations were applied.Results:In total, 344 studies were identified, of which 16 were included, reporting on 934 PEGs and 1093 PRGs. No differences were found for infectious complications [RD, 0.03 (-0.05 to 0.11)], procedure-related mortality [RD, 0.01 (-0.04 to 0.06)], or 30-day mortality [RD, 0.06 (-0.01 to 0.13)]. Tube-related complications were higher in PRG [RD, 0.16 (0.06-0.26)]. Subgroup analysis was performed for head and neck cancer (HNC) and motor neuron disease. In HNC, this revealed significantly lower tube-related complications and procedure-related mortality after PEG. In motor neuron disease, no differences were seen. The level of evidence appears sufficient considering the low degree of heterogeneity.Conclusions:No differences were found with regard to mortality or infectious complications. PEG showed lower risk of tube-related complications. Subgroup analysis revealed PEG to be favorable in HNC based on lower rates of procedure-related mortality and tube-related complications. Local experience and availability should be taken into account in the decision process.
AB - Background:The optimal technique for long-term enteral feeding has not yet been established. Both percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are widely used. Aim was to extensively review outcomes of PEG and PRG.Materials and Methods:A systematic review using Medline, Embase, and Cochrane was performed, using standardized tools for assessing bias. Main outcomes were infectious and tube-related complications, procedure related and 30-day mortality. Pooled risk differences (RDs) with corresponding 95% confidence intervals (95% CIs) were calculated using random effects. Arcsine transformations were applied.Results:In total, 344 studies were identified, of which 16 were included, reporting on 934 PEGs and 1093 PRGs. No differences were found for infectious complications [RD, 0.03 (-0.05 to 0.11)], procedure-related mortality [RD, 0.01 (-0.04 to 0.06)], or 30-day mortality [RD, 0.06 (-0.01 to 0.13)]. Tube-related complications were higher in PRG [RD, 0.16 (0.06-0.26)]. Subgroup analysis was performed for head and neck cancer (HNC) and motor neuron disease. In HNC, this revealed significantly lower tube-related complications and procedure-related mortality after PEG. In motor neuron disease, no differences were seen. The level of evidence appears sufficient considering the low degree of heterogeneity.Conclusions:No differences were found with regard to mortality or infectious complications. PEG showed lower risk of tube-related complications. Subgroup analysis revealed PEG to be favorable in HNC based on lower rates of procedure-related mortality and tube-related complications. Local experience and availability should be taken into account in the decision process.
KW - gastrostomy
KW - enteral feeding
KW - percutaneous endoscopic gastrostomy
KW - percutaneous radiologic gastrostomy
KW - complications
KW - endoscopy
KW - AMYOTROPHIC-LATERAL-SCLEROSIS
KW - NECK-CANCER PATIENTS
KW - RISK-FACTORS
KW - TUBE PLACEMENT
KW - SURGICAL GASTROSTOMY
KW - INSERTED GASTROSTOMY
KW - HEAD
KW - MORTALITY
KW - PEG
KW - GASTROJEJUNOSTOMY
U2 - 10.1097/MCG.0000000000001082
DO - 10.1097/MCG.0000000000001082
M3 - (Systematic) Review article
C2 - 29924079
SN - 0192-0790
VL - 52
SP - 753
EP - 764
JO - Journal of Clinical Gastroenterology
JF - Journal of Clinical Gastroenterology
IS - 9
ER -