Outcomes of stroke patients undergoing percutaneous endoscopic gastrostomy: a systematic review and meta-analysis

Percutaneous endoscopic gastrostomy (P.E.G.) is recommended for stroke patients with dysphagia to sustain oral nutrition.

This study assesses the outcomes of stroke patients undergoing P.E.G. compared with those requiring nasogastric tube (N.G.T) or control group.

We performed a thorough search across five electronic databases to gather pertinent studies. Outcomes were analyzed using relative risk (R.R.) for categorical data and mean difference (M.D.) for continuous data, each with 95% confidence intervals (C.I.). The single-arm meta-analysis results were presented as proportions or mean changes, also with 95% C.I.

We included 22 studies consisting of 996,567 patients. Our double-arm meta-analysis (924,134 patients) revealed no significant difference in post-hospitalization or in-hospital mortality between P.E.G. and control groups. However, P.E.G. patients showed a higher risk of aspiration pneumonia than control (R.R. = 11.72[3.75, 36.62], p < 0.00001). A comparison of P.E.G. and N.G.T. in three studies involving 691 patients indicated a non-significant difference in-hospital mortality risk (R.R. = 0.59, 95% C.I. [0.2, 1.72]). The single-arm analysis of stroke patients with P.E.G. identified a 19.8% in-hospital mortality, 13.6% rate of aspiration pneumonia, and 58% rate of pneumonia.

Stroke patients undergoing P.E.G remain at high risk for aspiration pneumonia and with an in-hospital mortality suggesting the need for identifying the best candidates and timing for the procedure.