Outcomes of early compared with delayed initiation of feeding after placement of percutaneous endoscopic gastrostomy tube: A systematic review and meta-analysis.

Abstract

Background: Certain guidelines consider feeding within 4 h of percutaneous endoscopic gastrostomy tube (PEG) placement to be safe. However, the evidence supporting the recommendations has been questioned and variation in feeding initiation practices persists, with feeding delayed up to 24 h after PEG placement. Our objective was to systematically review the current literature on early vs delayed feeding after PEG placement and compare their outcome in a meta-analysis.

Methods: Ovid MEDLINE, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched from inception until December 4, 2023. Randomized and nonrandomized studies comparing feeding initiation ≤4 vs >4 h post-PEG in adults were included. Independent extraction was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines and data were pooled using fixed or random-effects models. Measured outcomes were the odds of postoperative vomiting, diarrhea, stoma leakage, stoma infection, bleeding, intra-abdominal infection, aspiration pneumonia, and 30-day mortality. Assessment of risk of bias was completed using the Cochrane risk of bias tool 2 (RoB 2) for randomized studies and the Newcastle-Ottawa scale for nonrandomized studies. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42023483520.

Results: Of 4751 studies, 11 with 2880 patients met inclusion. There was no significant difference in all the measured outcomes between groups, but the evidence certainty was low to very low. Intra-abdominal infection couldn't be examined because of scarce reporting by authors.

Conclusion: This robust meta-analysis suggests early feeding after PEG placement is likely safe but uncertain, highlighting the need for a high-quality randomized trial.