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Comparative Analysis of Early Versus Late Feeding Post-percutaneous Endoscopic Gastrostomy Tube Placement: A
Mahesh Gajendran1, Eric Smith2, Priyadarshini Loganathan3
1Gastroenterology, University of Texas Health Science Center, San Antonio, TX, USA. gajendran@uthscsa.edu.
Insights
Starting tube feedings within 4 hours of percutaneous endoscopic gastrostomy (PEG) tube placement is safe and effective. Early feeding after PEG placement does not increase complication or mortality rates, offering potential benefits like reduced hospital stays.
Area of Science:
- Gastroenterology
- Clinical Nutrition
- Medical Procedures
Background:
- Delayed initiation of tube feedings post-percutaneous endoscopic gastrostomy (PEG) placement is common despite evidence supporting early feeding.
- Previous meta-analyses indicate that initiating tube feeding within 4 hours of PEG placement is safe.
Purpose of the Study:
- To conduct an updated meta-analysis comparing early (≤4 hours) versus delayed (>4 hours) tube feeding after PEG placement.
- To evaluate the impact of early feeding on complication and mortality rates within 72 hours post-procedure.
Main Methods:
- Systematic search of PubMed, EMBASE, and Web of Science for randomized controlled trials (RCTs) up to June 2022.
- Analysis of six RCTs involving adult patients undergoing PEG tube placement.
- Pooled odds ratios (95% CI) were calculated for complication and mortality rates.
Main Results:
- Analysis included 212 patients in the early feeding group and 215 in the delayed feeding group.
- No significant increase in total complication events (OR 0.86, CI 0.51-1.45, p=0.58) was observed with early feeding.
- Specific complications like fever, vomiting, and local infection also showed no significant difference between groups.
Conclusions:
- Early feeding (≤4 hours) after PEG placement is safe and well-tolerated, with no increased risk of complications or mortality.
- Early initiation of tube feeding is an effective alternative to delayed feeding and may lead to shorter hospital stays and reduced healthcare costs.
Introduction:
In clinical practice, tube feedings have been delayed after the percutaneous endoscopic gastrostomy (PEG) tube placement. Previous studies, including a meta-analysis in 2008, have shown that it is safe to start tube feeding ≤ 4 h of PEG tube placement. However, it is still a common practice to delay the initiation of tube feeding up to 24 h after PEG tube placement. We have performed an updated analysis of studies comparing early versus delayed tube feedings following PEG placement.
Methods:
Major databases like PubMed, EMBASE, and Web of Science were searched in June 2022 for randomized controlled trial (RCT) studies reporting on comparative outcomes with early (< or = 4 h) versus delayed (> 4 h) feeding after PEG tube placement in adult patients. The primary outcomes in our study include complication rates and mortality rates within 72 h of the procedure. The outcomes were reported as pooled odds ratio (95% confidence interval (CI) (Moole et al. in Indian J Gastroenterol. 35:323-330, 2016), p value, I2 values).
Results:
A total of 212 individuals in the early feeding group and 215 individuals in the late feeding group were analyzed from six studies. The pooled odds ratio of total complication events between early and late feed groups was 0.86 (CI 0.51-1.45, p = 0.58). The pooled odds ratio of fever, vomiting, and local infection was 0.94 (CI 0.186-4.74, p = 0.94), 1.0 (CI 0.38-2.65, p = 0.9), and 1.25 (0.36-4.3, p = 0.72), respectively, between early and late feeding post-PEG tube placement. In conclusion, this meta-analysis confirms that early feeding ≤ 4 h after PEG placement does not increase the odds of poor outcomes or mortality, and it is a well-tolerated, safe, and effective alternative to delayed feeding. Furthermore, early feeding may decrease hospital stays and healthcare costs.
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