Enteral feeding within three hours after percutaneous endoscopic gastrostomy placement: a meta-analysis.

BACKGROUND

Traditionally, tube feedings have been delayed after gastrostomy placement to the next day and up to 24 hours postprocedure. However, results from various randomized clinical trials (RCTs) indicate earlier feeding may be an option. Therefore, we conducted a meta-analysis to analyze the effect of earlier feedings (≤3 h) after percutaneous endoscopic gastrostomy (PEG) placement.

METHODS

Various medical databases and recent abstracts from major conference proceedings were searched (8/09). Only RCTs on adult subjects that compared early (≤3 h) versus delayed or next-day feedings after PEG placement were included. Meta-analysis was performed using pooled estimates of complications, death ≤72 hours, and significant increases in the number of postprocedural gastric residual volume during day 1 using odds ratio (OR) with the fixed and random effects models. Heterogeneity was assessed by calculating the I2 measure of inconsistency. RevMan 5.0 was utilized for statistical analysis.

RESULTS

Five studies (N=355) met the inclusion criteria. No significant differences were noted between early (≤3 h) and delayed or next day feedings for patient complications [OR 0.78; 95% confidence interval (CI), 0.39-1.53; P=0.47], death in ≤72 hours (OR 0.60; 95% CI, 0.18-1.99; P=0.40), and number of significant gastric residual volume during day 1 (OR 1.46; 95% CI, 0.75-2.84; P=0.27). No publication bias and no significant heterogeneity were noted.

CONCLUSIONS

Early tube feeding ≤3 hours after PEG placement has no significant differences to delayed or next-day feeding in respect to complications, death in ≤72 hours, or number of significant gastric residual volumes at day 1.