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. 2016 Oct;14(4):333-342.
doi: 10.5217/ir.2016.14.4.333. Epub 2016 Oct 17.

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Joo Hyun Lim  1 , Seung Ho Choi  1 , Changhyun Lee  1 , Ji Yeon Seo  1 , Hae Yeon Kang  1 , Jong In Yang  1 , Su Jin Chung  1 , Joo Sung Kim  1
Affiliations

Thirty-day mortality after percutaneous gastrostomy by endoscopic versus radiologic placement: a systematic review and meta-analysis

Joo Hyun Lim et al. Intest Res. 2016 Oct.

Abstract

Background/aims: A percutaneous gastrostomy can be placed either endoscopically (percutaneous endoscopic gastrostomy, PEG) or radiologically (radiologically-inserted gastrostomy, RIG). However, there is no consistent evidence of the safety and efficacy of PEG compared to RIG. Recently, 30-day mortality has become considered as the most important surrogate index for evaluating the safety and efficacy of percutaneous gastrostomy. The aim of this meta-analysis was to compare the 30-day mortality rates between PEG and RIG.

Methods: Major electronic databases (MEDLINE, Embase, Scopus, and Cochrane library) were queried for comparative studies on the two insertion techniques of gastrostomy among adults with swallowing disturbance. The primary outcome was the 30-day mortality rate after gastrostomy insertion. Forest and funnel plots were generated for outcomes using STATA version 14.0.

Results: Fifteen studies (n=2,183) met the inclusion criteria. PEG was associated with a lower risk of 30-day mortality after tube placement compared with RIG (odds ratio, 0.60; 95% confidence interval [CI], 0.38-0.94; P=0.026). The pooled prevalence of 30-day mortality of PEG was 5.5% (95% CI, 4.0%-6.9%) and that of RIG was 10.5% (95% CI, 6.8%-14.3%). No publication bias was noted.

Conclusions: The present meta-analysis demonstrated that PEG is associated with a lower probability of 30-day mortality compared to RIG, suggesting that PEG should be considered as the first choice for long-term enteral tube feeding. Further prospective randomized studies are needed to evaluate and compare the safety of these two different methods of gastrostomy.

Keywords: Endoscopy; Fluoroscopy; Gastrostomy; Mortality.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1. Preferred reporting items for systematic review and meta-analyses diagram of the included articles.
Fig. 2
Fig. 2. Forest plot of 30-day mortality after gastrostomy tube insertion. (A) Fixed effect model. (B) Random effect model.
Fig. 3
Fig. 3. Funnel plot of 30-day mortality after gastrostomy tube insertion.
Fig. 4
Fig. 4. Subgroup analysis of patients with motor neuron disease. (A) Forest plot of 30-day mortality after gastrostomy tube insertion. (B) Funnel plot of 30-day mortality after gastrostomy tube insertion.
Fig. 5
Fig. 5. Subgroup analysis in patients with head and neck cancer. (A) Forest plot of 30-day mortality after gastrostomy tube insertion. (B) Funnel plot of 30-day mortality after gastrostomy tube insertion.
See this image and copyright information in PMC

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