Yuan Yong, Zhao Yongfan, Xie Tianpeng, Hu Yang
Department of Thoracic Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
Cochrane Database Syst Rev. 2016 Feb 3;2(2):CD009198. doi: 10.1002/14651858.CD009198.pub2.
Gastrostomy has been established as the standard procedure for administering long-term enteral nutrition in individuals with swallowing disturbances. Percutaneous gastrostomy is a less-invasive approach than open surgical gastrostomy, and can be accomplished via endoscopy (percutaneous endoscopic gastrostomy or PEG) or sonographic or fluoroscopic guidance (percutaneous radiological gastrostomy or PRG). Both techniques have different limitations, advantages, and contraindications. In order to determine the optimal technique for long-term nutritional supplementation many studies have been conducted to compare the outcomes of these two techniques; however, it remains unclear as to which method is superior to the other with respect to both efficacy and safety.
To compare the safety and efficacy of PEG and PRG in the treatment of individuals with swallowing disturbances.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, January 2016); MEDLINE (1946 to 22 January 2016); EMBASE (1980 to 22 January 2016); the reference lists of identified articles; databases of ongoing trials, including the Chinese Cochrane Centre Controlled Trials Register; and PubMed. We applied no language restrictions.
Randomised controlled trials (RCTs) comparing PEG with PRG in individuals with swallowing disturbances, regardless of the underlying disease.
Two authors independently evaluated the search results and assessed the quality of the studies. Data analyses could not be performed as no RCTs were identified for inclusion in this review.
We identified no RCTs comparing PEG and PRG for percutaneous gastrostomy in individuals with swallowing disturbances. The large body of evidence in this field comes from retrospective and non-randomised controlled studies and case series. Based on this evidence, both PEG and PRG can be safely performed in selected individuals, although both are associated with major and minor complications. A definitive RCT has yet to be conducted to identify the preferred percutaneous gastrostomy technique.
AUTHORS' CONCLUSIONS: Both PEG and PRG are effective for long-term enteral nutritional support in selected individuals, though current evidence is insufficient to recommend one technique over the other. Choice of technique should be based on indications and contraindications, operator experience and the facilities available. Large-scale RCTs are required to compare the two techniques and to determine the optimal approach for percutaneous gastrostomy.
胃造口术已成为吞咽障碍患者长期肠内营养支持的标准方法。经皮胃造口术是一种比开放性外科胃造口术侵入性更小的方法，可通过内镜（经皮内镜下胃造口术或PEG）或超声或荧光透视引导（经皮放射学胃造口术或PRG）来完成。两种技术都有不同的局限性、优点和禁忌证。为了确定长期营养补充的最佳技术，已经进行了许多研究来比较这两种技术的效果；然而，关于哪种方法在疗效和安全性方面优于另一种方法仍不清楚。
比较PEG和PRG治疗吞咽障碍患者的安全性和有效性。
我们检索了Cochrane对照试验中心注册库（CENTRAL）（Cochrane图书馆，2016年1月）；MEDLINE（1946年至2016年1月22日）；EMBASE（1980年至2016年1月22日）；已识别文章的参考文献列表；正在进行试验的数据库，包括中国Cochrane中心对照试验注册库；以及PubMed。我们没有设置语言限制。
比较PEG与PRG治疗吞咽障碍患者的随机对照试验（RCT），无论潜在疾病如何。
两位作者独立评估检索结果并评估研究质量。由于未识别出可纳入本综述的RCT，因此无法进行数据分析。
我们未识别出比较PEG与PRG用于吞咽障碍患者经皮胃造口术的RCT。该领域的大量证据来自回顾性研究、非随机对照研究和病例系列。基于这些证据，PEG和PRG在选定个体中均可安全实施，尽管两者都伴有严重和轻微并发症。尚未进行确定性RCT以确定首选的经皮胃造口术技术。
PEG和PRG对选定个体的长期肠内营养支持均有效，但目前证据不足以推荐一种技术优于另一种技术。技术选择应基于适应证和禁忌证、操作者经验及可用设备。需要大规模RCT来比较这两种技术并确定经皮胃造口术的最佳方法。
