Departments of Internal Medicine, Division of Gastroenterology and Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism.
Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
J Clin Gastroenterol. 2018 Oct;52(9):753-764. doi: 10.1097/MCG.0000000000001082.
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.
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.
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.
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.
长期肠内喂养的最佳技术尚未确定。经皮内镜胃造口术（PEG）和经皮放射胃造口术（PRG）均被广泛应用。本研究旨在广泛回顾 PEG 和 PRG 的结果。
使用 Medline、Embase 和 Cochrane 进行系统评价，并使用标准化工具评估偏倚。主要结局为感染和管相关并发症、操作相关和 30 天死亡率。使用随机效应计算汇总风险差异（RD）及其相应的 95%置信区间（95%CI）。应用反正弦变换。
共确定 344 项研究，其中 16 项研究纳入了 934 例 PEG 和 1093 例 PRG，结果显示两组间感染性并发症[RD，0.03（-0.05 至 0.11）]、操作相关死亡率[RD，0.01（-0.04 至 0.06）]或 30 天死亡率[RD，0.06（-0.01 至 0.13）]均无差异。PRG 组管相关并发症较高[RD，0.16（0.06-0.26）]。对头颈部癌症（HNC）和运动神经元病进行了亚组分析。在 HNC 中，PEG 组的管相关并发症和操作相关死亡率明显较低。在运动神经元病中，两组无差异。考虑到低异质性，证据水平似乎足够。
死亡率或感染性并发症方面无差异。PEG 组发生管相关并发症的风险较低。亚组分析显示，基于较低的操作相关死亡率和管相关并发症发生率，PEG 在 HNC 中更为有利。决策过程中应考虑当地经验和可用性。
