Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 May 22;2015(5):CD008096.
doi: 10.1002/14651858.CD008096.pub4.

Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances

Claudio A R Gomes Jr  1 , Régis B Andriolo, Cathy Bennett, Suzana A S Lustosa, Delcio Matos, Daniel R Waisberg, Jaques Waisberg
Affiliations
Meta-Analysis

Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances

Claudio A R Gomes Jr et al. Cochrane Database Syst Rev. .

Abstract

Background: A number of conditions compromise the passage of food along the digestive tract. Nasogastric tube (NGT) feeding is a classic, time-proven technique, although its prolonged use can lead to complications such as lesions to the nasal wing, chronic sinusitis, gastro-oesophageal reflux, and aspiration pneumonia. Another method of infusion, percutaneous endoscopy gastrostomy (PEG), is generally used when there is a need for enteral nutrition for a longer time period. There is a high demand for PEG in patients with swallowing disorders, although there is no consistent evidence about its effectiveness and safety as compared to NGT.

Objectives: To evaluate the effectiveness and safety of PEG compared with NGT for adults with swallowing disturbances.

Search methods: We searched The Cochrane Library, MEDLINE, EMBASE, and LILACS from inception to January 2014, and contacted the main authors in the subject area. There was no language restriction in the search.

Selection criteria: We planned to include randomised controlled trials comparing PEG versus NGT for adults with swallowing disturbances or dysphagia and indications for nutritional support, with any underlying diseases. The primary outcome was intervention failure (e.g. feeding interruption, blocking or leakage of the tube, no adherence to treatment).

Data collection and analysis: We used standard methodological procedures expected by The Cochrane Collaboration. For dichotomous and continuous variables, we used risk ratio (RR) and mean difference (MD), respectively with the random-effects statistical model and 95% confidence interval (CI). We assumed statistical heterogeneity when I² > 50%.

Main results: We included 11 randomised controlled studies with 735 participants which produced 16 meta-analyses of outcome data. Meta-analysis indicated that the primary outcome of intervention failure, occurred in lower proportion of participants with PEG compared to NGT (RR 0.18, 95% CI 0.05 to 0.59, eight studies, 408 participants, low quality evidence) and this difference was statistically significant. For this outcome, we also subgrouped the studies by endoscopic gastrostomy technique into pull, and push and not reported. We observed a significant difference favouring PEG in the pull subgroup (RR 0.07, 95% CI 0.01 to 0.35, three studies, 90 participants). Thepush subgroup contained only one clinical trial and the result favoured PEG (RR 0.05, 95% CI 0.00 to 0.74, one study, 33 participants) techniques. We found no statistically significant difference in cases where the technique was not reported (RR 0.43, 95% CI 0.13 to 1.44, four studies, 285 participants).There was no statistically significant difference between the groups for meta-analyses of the secondary outcomes of mortality (RR 0.86, 95% CI 0.58 to 1.28, 644 participants, nine studies, very low quality evidence), overall reports of any adverse event at any follow-up time point (ITT analysis, RR 0.83, 95% CI 0.51 to 1.34), 597 participants, 6 studies, moderate quality evidence), specific adverse events including pneumonia (aspiration) (RR 0.70, 95% CI 0.46 to 1.06, 645 participants, seven studies, low quality evidence), or for the meta- analyses of the secondary outcome of nutritional status including weight change from baseline, and mid-arm circumference at endpoint, although there was evidence in favour of PEG for meta-analyses of mid-arm circumference change from baseline (MD 1.16, 95% CI 1.01 to 1.31, 115 participants, two studies), and levels of serum albumin were higher in the PEG group (MD 6.03, 95% CI 2.31 to 9.74, 107 participants).For meta-analyses of the secondary outcomes of time on enteral nutrition, there was no statistically significant difference (MD 14.48, 95% CI -2.74 to 31.71; 119 participants, two studies). For meta-analyses of quality of life measures (EuroQol) outcomes in two studies with 133 participants, for inconvenience (RR 0.03, 95% CI 0.00 to 0.29), discomfort (RR 0.03, 95% CI 0.00 to 0.29), altered body image (RR 0.01, 95% CI 0.00 to 0.18; P = 0.001) and social activities (RR 0.01, 95% CI 0.00 to 0.18) the intervention favoured PEG, that is, fewer participants found the intervention of PEG to be inconvenient, uncomfortable or interfered with social activities. However, there were no significant differences between the groups for pain, ease of learning to use, or the secondary outcome of length of hospital stay (two studies, 381 participants).

Authors' conclusions: PEG was associated with a lower probability of intervention failure, suggesting the endoscopic procedure may be more effective and safe compared with NGT. There is no significant difference in mortality rates between comparison groups, or in adverse events, including pneumonia related to aspiration. Future studies should include details of participant demographics including underlying disease, age and gender, and the gastrostomy technique.

PubMed Disclaimer

Conflict of interest statement

None known.

Dr Cathy Bennett is the proprietor of Systematic Research Ltd and received a consultancy fee from the Cochrane UGPD group to assist the authors with the update of their review in 2014.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 PEG versus NGT, Outcome 1 Intervention failure.
1.2
1.2. Analysis
Comparison 1 PEG versus NGT, Outcome 2 Non adherence to treatment.
1.3
1.3. Analysis
Comparison 1 PEG versus NGT, Outcome 3 Intervention failure (subgrouped by gastrostomy technique).
1.4
1.4. Analysis
Comparison 1 PEG versus NGT, Outcome 4 Intervention failure (subgrouped by baseline disease).
1.5
1.5. Analysis
Comparison 1 PEG versus NGT, Outcome 5 ITT analyses.
1.6
1.6. Analysis
Comparison 1 PEG versus NGT, Outcome 6 Mortality irrespective of follow‐up time.
1.7
1.7. Analysis
Comparison 1 PEG versus NGT, Outcome 7 Mean survival (months).
1.8
1.8. Analysis
Comparison 1 PEG versus NGT, Outcome 8 Adverse effects irrespective of follow‐up time.
1.9
1.9. Analysis
Comparison 1 PEG versus NGT, Outcome 9 Adverse effects irrespective of follow‐up time.
1.10
1.10. Analysis
Comparison 1 PEG versus NGT, Outcome 10 Pneumonia irrespective of follow‐up time.
1.11
1.11. Analysis
Comparison 1 PEG versus NGT, Outcome 11 Reflux oesophagitis.
1.12
1.12. Analysis
Comparison 1 PEG versus NGT, Outcome 12 Weight kg (endpoint).
1.13
1.13. Analysis
Comparison 1 PEG versus NGT, Outcome 13 Weight (change from baseline).
1.14
1.14. Analysis
Comparison 1 PEG versus NGT, Outcome 14 Mid‐arm circumference in cm (endpoint).
1.15
1.15. Analysis
Comparison 1 PEG versus NGT, Outcome 15 Mid‐arm circumference in cm (change from baseline).
1.16
1.16. Analysis
Comparison 1 PEG versus NGT, Outcome 16 Albumin.
1.17
1.17. Analysis
Comparison 1 PEG versus NGT, Outcome 17 Albumin (change from baseline).
1.18
1.18. Analysis
Comparison 1 PEG versus NGT, Outcome 18 Haemoglobin g/dL (change from baseline).
1.19
1.19. Analysis
Comparison 1 PEG versus NGT, Outcome 19 Score of patients satisfaction.
1.20
1.20. Analysis
Comparison 1 PEG versus NGT, Outcome 20 Score of inconvenience by nurses.
1.21
1.21. Analysis
Comparison 1 PEG versus NGT, Outcome 21 Time on enteral nutrition (days).
1.22
1.22. Analysis
Comparison 1 PEG versus NGT, Outcome 22 Quality of life measures EORTC QLQ‐H&N35 number scoring 3 or 4 (worst).
1.23
1.23. Analysis
Comparison 1 PEG versus NGT, Outcome 23 Functional ability (MRS).
1.24
1.24. Analysis
Comparison 1 PEG versus NGT, Outcome 24 Length of hospital stay (days).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Baeten 1992 {published data only}
    1. Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscopic gastrostomy. A comparison. Scandinavian Journal of Gastroenterology 1992;194:95‐8. [PUBMED: 1298056] - PubMed
Bath 1997 {published data only}
    1. Bath PMW, Bath‐Hextall FJ, Smithard D. Interventions for dysphagia in acute stroke. Cochrane Database of Systematic Reviews 1999, Issue 4. [DOI: 10.1002/14651858.CD000323] - DOI - PubMed
Corry 2008 {published data only}
    1. Corry J, Poon W, McPhee N, Milner AD, Cruickshank D, Porceddu SV, et al. Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation. Journal of Medical Imaging and Radiation Oncology 2008;52(5):503‐10. [PUBMED: 19032398] - PubMed
Dennis 2005 {published data only}
    1. Dennis M, Lewis S, Cranswick G, Forbes J, FOOD Trial Collaboration. FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technology Assessment 2006;10(2):iii‐iv, ix‐x, 1‐120. - PubMed
    1. Dennis MS, Lewis SC, Warlow C. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD):a multicentre randomised controlled trial. Lancet 2005;365:764‐72. [PUBMED: 15733717] - PubMed
Douzinas 2006 {published data only}
    1. Douzinas EE, Tsapalos A, Dimitrakopoulos A, Diamanti‐Kandarakis E, Rapidis AD, Roussos C. Effect of percutaneous endoscopic gastrostomy on gastro‐esophageal reflux in mechanically‐ventilated patients. World Journal of Gastroenterology 2006;12(1):114‐8. [PUBMED: 16440428] - PMC - PubMed
Elbadawy 2014 {unpublished data only}
    1. Elbadawy TH, Gamal MA, Fayed AM, Habib TN. Early gastrostomy and tracheostomy prevent ventilator associated pneumonia in traumatic brain injured patients. European Society of Intensive Care Medicine (ESICM) Congress. Springer Verlag. S123 http://www.esicm.org/flash‐conferences/lisbon‐2012/3143 accessed 4th April 2014 13‐17 October 2012.
    1. Fayed AM, Elbadawy TH, Gamal MA, Habib TN. Role of early gastrostomy and tracheostomy in prevention of VAP in traumatic brain injured patients. Unpublished manuscript received 8 April 2014.
Hamidon 2006 {published data only}
    1. Hamidon BB, Abdullah SA, Zawawi MF, Sukumar N, Aminuddin A, Raymond AA. A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke. Medical Journal of Malaysia 2006;61(1):59‐66. [PUBMED: 16708735] - PubMed
Norton 1996 {published data only}
    1. Kearns PJ. A randomized prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. Journal of Parenteral and Enteral Nutrition 1996;20(5):374‐5. [DOI: 10.1177/014860719602000513] - DOI
    1. Norton B, Homer‐Ward M, Donnelly MT, Long RG, Holmes GK. A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 1996;312(7022):13‐6. [PUBMED: 8555849] - PMC - PubMed
Park 1992 {published data only}
    1. Park RHR, Allison MC, Lang J, Spence E, Morris AJ, Danesh BJ, et al. Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia. BMJ 1992;304(6839):1406‐9. [PUBMED: 1628013] - PMC - PubMed
Sadasivan 2012 {published data only}
    1. Sadasivan A, Faizal B, Kumar M. Nasogastric and percutaneous endoscopic gastrostomy tube use in advanced head and neck cancer patients: a comparative study. Journal of Pain & Palliative Care Pharmacotherapy. 2012/09/15 2012; Vol. 26, issue 3:226‐32. [1536‐0288; PUBMED: 22973911] - PubMed
Yata 2001 {published data only}
    1. Yata M, Date K, Miyoshi H, Matsuo N, Nishida M, Harima T, et al. Comparison between nasogastric tube feeding and percutaneous endoscopic gastrostomy feeding: a long‐term randomized controlled study. Gastrointestinal Endoscopy. 2001; Vol. 53, issue 5:AB206.

References to studies excluded from this review

McClave 2005 {published data only}
    1. McClave SA, Lukan JK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Critical Care Medicine 2005;33(2):324‐30. - PubMed
Mekhail 2001 {published data only}
    1. Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P. Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube?. Cancer 2001;91(9):1785‐90. - PubMed
Schulz 2009 {published data only}
    1. Schulz RJ, Nieczaj R, Moll A, Azzaro M, Egge K, Becker R. Dysphagia treatment in a clinical‐geriatric setting PEG and functional therapy of dysphagia [Behandlung der Dysphagie in einem klinisch‐geriatrischen Setting: funktionelle Dysphagietherapie und PEG‐Einsatz.]. Zeitschrift für Gerontologie und Geriatrie 2009;42(4):328‐35. [PUBMED: 19618229] - PubMed

Additional references

Abdel‐Lah Mohamed 2006
    1. Abdel‐Lah Mohamed A, Abdel‐Lah Fernández O, Sánchez Fernández J, Pina Arroyo J, Gómez Alonso A. Surgical access routes in enteral nutrition [A Vías de acceso quirúrgico en nutrición enteral]. Cirugía, Ginecología y Urología 2006;79(6):331‐41. [PUBMED: 16768996] - PubMed
Anderson 2004
    1. Anderson MR, O'Connor M, Mayer P, O'Mahony D, Woodward J, Kane K. The nasal loop provides an alternative to percutaneous endoscopic gastrostomy in high‐risk dysphagic stroke patients. Clinical Nutrition 2004;23(4):501‐6. [PUBMED: 15297085] - PubMed
Anis 2006
    1. Anis MK, Abid S, Jafri W, Abbas Z, Shah HA, Hamid S, et al. Acceptability and outcomes of the percutaneous endoscopic gastrostomy (PEG) tube placement‐‐patients' and care givers' perspectives. BMC Gastroenterology 2006;24(6):37. [PUBMED: 17125502] - PMC - PubMed
Barker 2011
    1. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. International Journal of Environmental Research and Public Health 2011;8(2):514‐27. [PUBMED: 21556200] - PMC - PubMed
Barkmeier 1998
    1. BarkmeierJM, Trerotola SO, Wiebke EA, Sherman S, Harris VJ, Snidow JJ, et al. Percutaneous radiologic, surgical endoscopic, and percutaneous endoscopic gastrostomy/gastrojejunostomy: comparative study and cost analysis. Cardiovascular and Interventional Radiology 1998;21:324‐8. - PubMed
Bastow 1986
    1. Bastow MD. Complications of enteral nutrition. Gut 1986;27 Suppl 1:51‐5. [PUBMED: 3098642] - PMC - PubMed
Bath 1999
    1. Bath PMW, Bath‐Hextall FJ, Smithard DG. Interventions for dysphagia in acute stroke. Cochrane Database of Systematic Reviews 1999, Issue 4. [DOI: 10.1002/14651858.CD000323] - DOI - PubMed
Bath 2009
    1. Bath PMW. Personal correspondence (email to Cláudio Gomes Jr asking for the full text) 2009 (July‐16).
Beavan 2010
    1. Beavan J, Conroy SP, Harwood R, Gladman JR, Leonardi‐Bee J, Sach T, et al. Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial. Age and Ageing 2010;39(10):624‐30. [PUBMED: 20667840] - PubMed
Blumenstein 2014
    1. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions. World Journal of Gastroenterology 2014;20(26):8505‐24. [PUBMED: 25024606] - PMC - PubMed
Botella Romero 2012
    1. Botella Romero F, Alfaro Martínez JJ, Luna López V, Galicia Martín I, Grupo de Trabajo sobre Calcio y Vitamina D en Nutrición Enteral. Enteral nutrition in neurological patients: is there enough vitamin D content in commonly used formulas? [Nutricion enteral en el paciente neurologico: inverted question markes suficiente el contenido en vitamina D en las formulas de uso habitual?]. Nutrición Hospitalaria 2012;27(2):341‐8. [PUBMED: 22732955] - PubMed
Chiò 2004
    1. Chiò A, Galletti R, Finocchiaro C, Righi D, Ruffino MA, Calvo A, et al. Percutaneous radiological gastrostomy: a safe and effective method of nutritional tube placement in advanced ALS. Journal of Neurology, Neurosurgery and Psychiatry 2004;75(4):645‐7. - PMC - PubMed
Corry 2008b
    1. Corry J. Personal correspondence (e‐mail to Cláudio Gomes Jr asking for data about pneumonia and complications) 2008.
de Aguilar‐Nascimento 2011
    1. Aguilar‐Nascimento JE, Prado Silveira BR, Dock‐Nascimento DB. Early enteral nutrition with whey protein or casein in elderly patients with acute ischemic stroke: a double‐blind randomized trial. Nutrition 2011;27(4):440‐4. [PUBMED: 21167685] - PubMed
Dorman 1997
    1. Dorman PJ, Slattery J, Farrell B, Dennis MS, Sandercock PA. A randomised comparison of the EuroQol and Short Form‐36 after stroke. United Kingdom collaborators in the International Stroke Trial. Britsh Medical Journal 1997;315(7106):461. [PUBMED: 9284664] - PMC - PubMed
Dwolatzky 2001
    1. Dwolatzky T, Berezovski S, Friedmann R, Paz J, Clarfield AM, Stessman J, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long‐term enteral feeding in older people. Clinical Nutrition 2001;20(6):535‐40. [PUBMED: 11884002 ] - PubMed
Falsetti 2009
    1. Falsetti P, Acciai C, Palilla R, Bosi M, Carpinteri F, Zingarelli A, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. Journal of Stroke and Cerebrovascular Diseases 2009;18(5):329‐35. [PUBMED: 19717014] - PubMed
Finestone 2003
    1. Finestone HM, Greene‐Finestone LS. Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. Canadian Medical Association Journal 2003;169(10):1041‐4. [PUBMED: 14609974] - PMC - PubMed
Fini 2014
    1. Fini N, Georgoulopoulou E, Vinceti M, Monelli M, Pinelli G, Vacondio P, et al. Noninvasive and invasive ventilation and enteral nutrition for ALS in Italy. Muscle & Nerve 2014;50(4):508‐16. [PUBMED: 24448736] - PubMed
Friginal‐Ruiz 2011
    1. Friginal‐Ruiz AB, González‐Castillo S, Lucendo AJ. Endoscopic percutaneous gastrostomy: an update on the indications, technique and nursing care [Gastrostomía endoscópica percutánea: una actualización sobre indicaciones, técnica y cuidados de enfermería]. Enfermería Clínica 2011;21(3):173‐8. [PUBMED: 21530347] - PubMed
Gauderer 1980
    1. Gauderer MWL, Ponsky JL, Izant RJ Jr. Gastrostomy without laparotomy:a percutaneous endoscopic technique. Journal of Pediatric Surgery 1980;15(6):872‐5. [PUBMED: 6780678] - PubMed
Geeganage 2012
    1. Geeganage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database of Systematic Reviews 2012, Issue 10. [DOI: 10.1002/14651858.CD000323; PUBMED: 23076886] - DOI - PubMed
Gentile 2012
    1. Gentile MG. Enteral nutrition for feeding severely underfed patients with anorexia nervosa. Nutrients 2012;4(9):1293‐303. [PUBMED: 23112917] - PMC - PubMed
Gopalan 2003
    1. Gopalan S, Khanna S. Enteral nutrition delivery technique. Current Opinion in Clinical Nutrition and Metabolic Care 2003;6(3):313‐7. [PUBMED: 12690265] - PubMed
Granell Vidal 2014
    1. Granell Vidal L, Sánchez Juan C, Alfonso García A. Sensory evaluation of enteral nutritional supplements. Nutrición Hospitalaria 2014;30(1):104‐12. [PUBMED: 25137268] - PubMed
Grant 1988
    1. Grant JP. Comparison of percutaneous endoscopic gastrostomy with Stamm gastrostomy. Annals of Surgery 1988;207(5):598‐603. [PUBMED: 3377569] - PMC - PubMed
Heemskerk 2014
    1. Heemskerk AW, Verbist BM, Marinus J, Heijnen B, Sjögren EV, Roos RA. The Huntington's disease dysphagia scale. Movement Disorders 2014;29(10):1312‐6. [PUBMED: 24862624] - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Ho 2006
    1. Ho KM, Dobb GJ, Webb SA. A comparison of early gastric and post‐pyloric feeding in critically ill patients:a meta‐analysis. Intensive Care Medicine 2006;32(5):639‐49. [PUBMED: 16570149] - PubMed
Iwamoto 2014
    1. Iwamoto M, Higashibeppu N, Arioka Y, Nakaya Y. Swallowing rehabilitation with nutrition therapy improves clinical outcome in patients with dysphagia at an acute care hospital. The Journal of Medical Investigation 2014;61(3‐4):353‐60. [PUBMED: 25264054] - PubMed
Kolaček 2013
    1. Kolaček S. Enteral nutrition. World Review of Nutrition and Dietetics 2013;108:86‐90. [PUBMED: 24029791] - PubMed
Köhler 2014
    1. Köhler G, Kalcher V, Koch OO, Luketina RR, Emmanuel K, Spaun G. Comparison of 231 patients receiving either "pull‐through" or "push" percutaneous endoscopic gastrostomy. Surgical Endoscopy 2014;Epub ahead of print:3673‐9. [PUBMED: 24993173] - PubMed
Langmore 2006
    1. Langmore SE, Kasarskis EJ, Manca ML, Olney RK. Enteral tube feeding for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD004030.pub2] - DOI - PubMed
Le 2010
    1. Le HD, Fallon EM, Meijer VE, Malkan AD, Puder M, Gura KM. Innovative parenteral and enteral nutrition therapy for intestinal failure. Seminars in Pediatric Surgery 2010;19(1):27‐34. [PUBMED: 20123271] - PMC - PubMed
Ljungdahl 2006
    1. Ljungdahl M, Sundbom M. Complication rate lower after percutaneous endoscopic gastrostomy than after surgical gastrostomy: a prospective, randomized trial. Surgical Endoscopy 2006;20:1248‐51. [PUBMED: 16865614] - PubMed
Löser 2005
    1. Löser C, Aschl G, Hébuteme X, Mathus‐Vliegen EM, Muscaritoli M, Niv Y, et al. ESPEN guidelines on artificial enteral nutrition‐percutaneous endoscopic gastrostomy (PEG). Clinical Nutrition 2005;24(5):848‐61. [PUBMED: 16261664] - PubMed
Löser 2010
    1. Löser C. Malnutrition in hospital: the clinical and economic implications. Deutsches Ärzteblatt :International 2010;107(51‐52):911‐7. [PUBMED: 21249138] - PMC - PubMed
Manba 2014
    1. Manba N, Koyama Y, Kosugi S, Ishikawa T, Ichikawa H, Minagawa M, et al. Is early enteral nutrition initiated within 24 hours better for the postoperative course in esophageal cancer surgery?. Journal of Clinical Medicine Research 2014;6(1):53‐8. [PUBMED: 24400032] - PMC - PubMed
Marik 2003
    1. Marik PE, Zaloga GP. Gastric versus post pyloric feeding: a systematic review. Critical Care 2003;7(3):R46‐51. [PUBMED: 12793890] - PMC - PubMed
McClave 2008
    1. McClave 2008. Personal correspondence (email to Cláudio Gomes Jr concerning randomization) 2008.
Metheny 2010
    1. Metheny NA, Davis‐Jackson J, Stewart BJ. Effectiveness of an aspiration risk‐reduction protocol. Nursing Research 2010;59(1):18‐25. [PUBMED: 20010041] - PMC - PubMed
Moher 2001
    1. Moher D, Schulz KF, Altman DG, for the CONSORT Group. The CONSORT statement: revised recommendations for improving the quality of reports of parallel‐group randomised trials. Lancet 2001;357(9263):1191‐4. [PUBMED: 11323066] - PubMed
Nugent 2013
    1. Nugent B, Lewis S, O'Sullivan JM. Enteral feeding methods for nutritional management in patients with head and neck cancers being treated with radiotherapy and/or chemotherapy. Cochrane Database of Systematic Reviews 2013, Issue 1. [DOI: 10.1002/14651858.CD007904.pub3; PUBMED: 23440820] - DOI - PMC - PubMed
Ordoñez 2013
    1. Ordoñez AM, Madalozzo Schieferdecker ME, Cestonaro T, Cardoso Neto J, Ligocki Campos AC. Nutritional status influences the length of stay and clinical outcomes in patients hospitalized in internal medicine wards. Nutrición Hospitalaria 2013;28(4):1313‐20. [PUBMED: 23889658] - PubMed
Pearce 2002
    1. Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgraduate Medical Journal 2002;78(918):198‐204. [PUBMED: 11930022] - PMC - PubMed
Piecuch 2013
    1. Piecuch J, Wiewiora M, Latos W. Surgical treatment of a rare case of granular cell tumour of the cervical oesophagus. Wideochirurgia i Inne Techniki Mało Inwazyjne 2013;8(2):166‐9. [PUBMED: 23837102] - PMC - PubMed
Plonk 2005
    1. Plonk WM Jr. To PEG or not to PEG. Practical Gastroenterology 2005;29(7):16‐31. [https://www.healthsystem.virginia.edu/internet/digestive‐health/nutritio...
Poisson 2014
    1. Poisson P, Laffond T, Campos S, Dupuis V, Bourdel‐Marchasson I. Relationships between oral health, dysphagia and undernutrition in hospitalised elderly patients. Gerodontology 2014;Epub ahead of print:1‐8. [DOI: 10.1111/ger.12123; PUBMED: 24612262] - DOI - PubMed
Potack 2008
    1. Potack JZ, Chokhavatia S. Complications of and controversies associated with percutaneous endoscopic gastrostomy: report of a case and literature review. Medscape Journal of Medicine 2008;10(6):142. [MEDLINE: ] - PMC - PubMed
Ramel 2008
    1. Ramel A, Jonsson PV, Bjornsson S, Thorsdottir I. Anemia, nutritional status, and inflammation in hospitalized elderly. Nutrition 2008;24(11‐12):1116‐22. [PUBMED: 18692363] - PubMed
Scheeren 2014
    1. Scheeren B, Maciel AC, Barros SG. Videofluoroscopic Swallowing Study: esophageal alterations in patients with dysphagia [Videofluoroscopia da deglutição: alterações esofágicas em pacientes com disfagia]. Arquivos de Gastroenterologia 2014;51(3):221‐5. [PUBMED: 25296083] - PubMed
Schneider 2014
    1. Schneider AS, Schettler A, Markowski A, Luettig B, Kaufmann B, Klamt S, et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication‐dependent. *Conference presentation: 36th ESPEN Congress in Leipzig, Germany on August 31st – September 3rd, 2013. Scandinavian Journal of Gastroenterology 2014;49(7):891‐8. [PUBMED: 24896841] - PubMed
Schröder 2004
    1. Schröder O, Hoepffner N, Stein J. Enteral nutrition by endoscopic means; I. Techniques, indications, types of enteral feed. Zeitschrift für Gastroenterologie 2004;42(12):1385‐92. [PUBMED: 15592963] - PubMed
Simons 2014
    1. Simons JA, Fietzek UM, Waldmann A, Warnecke T, Schuster T, Ceballos‐Baumann AO. Development and validation of a new screening questionnaire for dysphagia in early stages of Parkinson's disease. Parkinsonism & Related Disorders 2014;20(9):992‐8. [PUBMED: 25012695] - PubMed
Skitt 2011
    1. Skitt LC, Hurley JJ, Turner JK, Green AJ, Pinch N, Dolwani S, et al. Helping the general physician to improve outcomes after PEG insertion: how we changed our practice. Clinical Medicine 2011;11(2):132‐7. [PUBMED: 21526693] - PMC - PubMed
Stec 2008
    1. Stec S, Tarnowski W, Binda A, Kulakowski P. Videofluoroscopic modified barium swallow study for premature ventricular complexes‐associated dysphagia. Circulation. Arrhythmia and Electrophysiology 2008;1(1):e1. [PUBMED: 19808385] - PubMed
Stiegmann 1990
    1. Stiegmann GV, Goff JS, Silas D, Pearlman N, Sun J, Norton L. Endoscopic versus operative gastrostomy: final results of a prospective randomized trial. Gastrointestinal Endoscopy 1990;36(1):1‐5. [PUBMED: 2107116] - PubMed
Tucker 2003
    1. Tucker AT, Gourin CG, Ghegan MD, Porubsky ES, Martindale RG, Terris DJ. 'Push' versus 'pull' percutaneous endoscopic gastrostomy tube placement in patients with advanced head and neck cancer. Laryngoscope 2003;113(11):1898‐902. [PUBMED: 14603043] - PubMed
Valente da Silva 2012
    1. Valente da Silva HG, Santos SO, Silva NO, Ribeiro FD, Josua LL, Moreira AS. Nutritional assessment associated with length of inpatients' hospital stay. Nutrición Hospitalaria 2012;27(2):542‐7. [PUBMED: 22732981] - PubMed
Wang 2014
    1. Wang J, Liu M, Liu C, Ye Y, Huang G. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for patients with head and neck cancer: a systematic review. Journal of Radiation Research 2014;55(3):559‐67. [PUBMED: 24453356] - PMC - PubMed
Wollman 1995
    1. Wollman B, D'Agostino HB, Walus‐Wigle JR, Easter DW, Beale A. Radiologic, endoscopic, and surgical gastrostomy: an institutional evaluation and meta‐analysis of the literature. Radiology 1995;197(3):699‐704. [PUBMED: 7480742] - PubMed
Zaherah 2012
    1. Zaherah Mohamed Shah F, Suraiya HS, Poi PJ, Tan KS, Lai PS, Ramakrishnan K, et al. Long‐term nasogastric tube feeding in elderly stroke patients‐‐an assessment of nutritional adequacy and attitudes to gastrostomy feeding in Asians. Journal of Nutrition, Health & Aging 2012;16(8):701‐6. [PUBMED: 23076512] - PubMed

References to other published versions of this review

Gomes 2010
    1. Gomes CAR Jr, Lustosa SA, Matos D, Andriolo RB, Waisberg DR, Waisberg J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database of Systematic Reviews 2010, Issue 11. [DOI: 10.1002/14651858.CD008096.pub2] - DOI - PubMed
Gomes 2012
    1. Gomes CAR Jr, Lustosa SAS, Matos D, Andriolo RB, Waisberg DR, Waisberg J. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database of Systematic Reviews 2012, Issue 3. [DOI: 10.1002/14651858.CD008096.pub3] - DOI - PubMed

Publication types

MeSH terms