CoChat
Sign Up
Cited by 44Dysphagia Assessment and ManagementClinical Nutrition and GastroenterologyNutrition and Health in Aging

Percutaneous endoscopic gastrostomy versus nasogastric feeding in older individuals with non-stroke dysphagia: A systematic review

Open access
Jaafar, M.H., Mahadeva, S., Morgan, K., Tan, M.P.·2015·The Journal of nutrition, health and aging
DOI 10.1007/s12603-014-0527-zPMC PMC12877540
Open this paper in CoChat — free account

Abstract

OBJECTIVE: The objective of this systematic review was to evaluate existing studies on the effectiveness of percutaneous endoscopic gastrostomy (PEG) feeding compared to nasogastric (NG) feeding for patients with non-stroke related dysphagia. METHODS: We searched Ovid MEDLINE, EMBASE, the Cochrane Library, Web of Science and PubMed databases through to December 2013 using the terms "percutaneous endoscopic gastrostomy", "gastrostomy", "PEG", "nasogastric", "nasogastric tube", "nasogastric feeding" and "intubation". We included randomized controlled trials (RCTs) and non-RCTs which compared PEG with NG feeding in individuals with non-stroke dysphagia. RESULTS: 9 studies involving 847 participants were included in the final analysis, including two randomized trials. Pooled analysis indicated no significant difference in the risk of pneumonia [relative risk (RR) = 1.18, 95% confidence interval (CI) = 0.87-1.60] and overall complications [relative risk (RR) = 0.80, 95% confidence interval (CI) = 0.63-1.02] between PEG and NG feeding. A meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective. CONCLUSIONS: Firm conclusions could not be derived on whether PEG feeding is beneficial over NG feeding in older persons with non-stroke dysphagia, as previously published literature were unclear or had a high risk of bias. A well-designed and adequately powered RCT, which includes carer strain and quality of life as outcome measures is therefore urgently needed.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1007/s12603-014-0527-z

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In a systematic review comparing nasogastric tube feeding with PEG feeding in older patients with non-stroke dysphagia, a pooled analysis of nine studies involving 847 patients demonstrated no significant differences in the risk of pneumonia and overall complications.

    “In a systematic review that compared nasogastric tube feeding with PEG feeding in older patients with non-stroke dysphagia, a pooled analysis of nine studies involving 847 patients demonstrated no significant differences in the risk of pneumonia and overall complications (166).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [166]

  • Within this review, three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective.

    “Within this review, a meta-analysis was not possible for mortality and nutritional outcomes, but three studies suggested improved mortality outcomes with PEG feeding while two out of three studies reported PEG feeding to be better from a nutritional perspective.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [166]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 38

  1. [1]Altman KW Yu GP Schaefer SD Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources Archives of otolaryngology—head & neck surgery 136 8 2010 784 789 10.1001/archoto.2010.129 20713754 · DOI
  2. [2]Cabre M Serra-Prat M Palomera E Almirall J Pallares R Clave P Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia Age Ageing. 39 1 2010 39 45 PubMed PMID: 19561160 10.1093/ageing/afp100 19561160 · DOI
  3. [3]Martino R Foley N Bhogal S Diamant N Speechley M Teasell R Dysphagia after stroke: incidence, diagnosis, and pulmonary complications Stroke 36 12 2005 2756 2763 PubMed PMID: 16269630 10.1161/01.STR.0000190056.76543.eb 16269630 · DOI · Paper page
  4. [4]Ekberg O Hamdy S Woisard V Wuttge-Hannig A Ortega P Social and Psychological Burden of Dysphagia: Its Impact on Diagnosis and Treatment Dysphagia 17 2002 139 146 PubMed PMID: 11956839 10.1007/s00455-001-0113-5 11956839 · DOI
  5. [5]Gentile S Lacroix O Durand AC Cretel E Alazia M Sambuc R Malnutrition: A highly predictive risk factor of short-term mortality in elderly presenting to the emergency department J Nutr Health Aging 17 4 2013 290 294 PubMed PMID: 23538647 10.1007/s12603-012-0398-0 23538647 · DOI
  6. [7]Masiero S Pierobon R Previato C Gomiero E Pneumonia in stroke patient with oropharyngeal dysphagia: a six-month follow-up study Neurological Sciences 29 3 2008 139 145 PubMed PMID: 18612760 10.1007/s10072-008-0925-2 18612760 · DOI
  7. [8]Sobotka L Schneider SM Berner YN Cederholm T Krznaric Z Shenkin A ESPEN Guidelines on Parenteral Nutrition: Geriatrics Clinical Nutrition 28 2009 461 466 PubMed PMID: 19464772 10.1016/j.clnu.2009.04.004 19464772 · DOI
  8. [9]Pancorbo-Hidalgo PL Garcia-Fernandez FP Ramirez-Perez C Complications associated with enteral nutrition by nasogastric tube in an internal medicine unit Journal of Clinical Nursing 10 4 2001 482 490 PubMed PMID: 11822496 10.1046/j.1365-2702.2001.00498.x 11822496 · DOI
  9. [10]Hamidon BB Abdullah SA Zawawi MF Sukumar N Aminuddin A Raymond AA A prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with acute dysphagic stroke Medical Journal of Malaysia 61 1 2006 59 66 PubMed PMID: 16708735 16708735
  10. [11]Norton B Homer-Ward M Donnelly MT Long RG Holmes GK A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke BMJ 312 7022 1996 13 16 PMCID 2349687; PubMed PMID: 8555849 10.1136/bmj.312.7022.13 8555849 PMC2349687 · DOI
  11. [12]Bath PM Bath FJ Smithard DG Interventions for dysphagia in acute stroke Cochrane database of systematic reviews 2 2000 000323 10796343
  12. [13]Moher D Liberati A Tetzlaff J Altman DG Group TP Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement PLoS Med 6 7 2009 1000097 10.1371/journal.pmed.1000097 PMC2707599 19621072 · DOI · Paper page
  13. [14]Higgins JPT Altman DG Gøtzsche PC Jüni P Moher D Oxman AD The Cochrane Collaboration's tool for assessing risk of bias in randomised trials BMJ 11 55 2011 48 PMC3196245 22008217
  14. [15]Ghosh S Eastwood MA Percutaneous Endoscopic Gastrostomy — a Users Perspective Journal of Human Nutrition and Dietetics 7 3 1994 231 235 10.1111/j.1365-277X.1994.tb00435.x · DOI
  15. [16]Hoffman MS Cardosi RJ Lemert R Drake JG Stamm gastrostomy for postoperative gastric decompression in gynecologic oncology patients Gynecologic Oncology 82 2 2001 360 363 PubMed PMID: 11531294 10.1006/gyno.2001.6268 11531294 · DOI
  16. [17]Pricolo VE Vittimberga GM Yellin SA Burchard KW Slotman GJ Decompression after gastric surgery. Gastrostomy versus nasogastric tube Am Surg. 55 7 1989 413 416 PubMed PMID: 2742224 2742224
  17. [18]Baeten C Hoefnagels J Feeding via nasogastric tube or percutaneous endoscopic gastrostomy A comparison. Scandinavian Journal of Gastroenterology — Supplement 194 1992 95 98 10.3109/00365529209096035 1298056 · DOI
  18. [19]Leibovitz A Dan M Zinger J Carmeli Y Habot B Segal R Pseudomonas aeruginosa and the oropharyngeal ecosystem of tube-fed patients Emerging Infectious Diseases 9 8 2003 956 959 PMCID 3020605; PubMed PMID: 12967493 10.3201/eid0908.030054 12967493 PMC3020605 · DOI
  19. [20]Maitines G Ugenti I Memeo R Clemente N Iambrenghi OC Endoscopic gastrostomy for enteral nutrition in neurogenic dysphagia: Application of a nasogastric tube or percutaneous endoscopic gastrostomy Chir Ital. 61 1 2009 33 38 PubMed PMID: 19391337 19391337
  20. [22]Park RH Allison MC Lang J Spence E Morris AJ Danesh BJ Randomised comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding in patients with persisting neurological dysphagia BMJ 304 6839 1992 1406 1409 PMCID 1882203; PubMed PMID: 1628013 10.1136/bmj.304.6839.1406 1628013 PMC1882203 · DOI
  21. [23]Lee TH Shiun YC Changes in gastroesophageal reflux in patients with nasogastric tube followed by percutaneous endoscopic gastrostomy Journal of the Formosan Medical Association = Taiwan yi zhi 110 2 2011 115 119 PubMed PMID: 21377066 10.1016/S0929-6646(11)60018-1 21377066 · DOI
  22. [24]Dwolatzky T Berezovski S Friedmann R Paz J Clarfield AM Stessman J A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people Clin Nutr. 20 6 2001 535 540 PubMed PMID: 11884002 10.1054/clnu.2001.0489 11884002 · DOI
  23. [25]Kumagai R Kubokura M Sano A Shinomiya M Ohta S Ishibiki Y Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia Psychiatry Clin Neurosci. 66 5 2012 418 422 PubMed PMID: 22834660 10.1111/j.1440-1819.2012.02378.x 22834660 · DOI
  24. [26]Attanasio A Bedin M Stocco S Negrin V Biancon A Cecchetto G Clinical outcomes and complications of enteral nutrition among older adults Minerva Medica 100 2 2009 159 166 PubMed PMID: 19390502 19390502
  25. [27]Azzopardi N Ellul P Pneumonia and mortality after percutaneous endoscopic gastrostomy insertion Turkish Journal of Gastroenterology 24 2 2013 109 116 PubMed PMID: 23934456 23934456
  26. [28]Ciocon JO Silverstone FA Graver LM Foley CJ Tube feedings in elderly patients. Indications, benefits, and complications Arch Intern Med. 148 2 1988 429 433 PubMed PMID: 3124777 10.1001/archinte.1988.00380020173022 3124777 · DOI
  27. [29]Rio A Ellis C Shaw C Willey E Ampong MA Wijesekera L Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease Journal of Human Nutrition and Dietetics 23 4 2010 408 415 PubMed PMID: 20487174 10.1111/j.1365-277X.2010.01057.x 20487174 · DOI
  28. [30]Gomes CA Jr Lustosa SA Matos D Andriolo RB Waisberg DR Waisberg J Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances Cochrane database of systematic reviews 3 2012 008096 22419328
  29. [31]Middleton MH Nazarenko G Nivison-Smith I Smerdely P Prevalence of malnutrition and 12-month incidence of mortality in two Sydney teaching hospitals Internal Medicine Journal 31 8 2001 455 461 PubMed PMID: 11720058 10.1046/j.1445-5994.2001.00109.x 11720058 · DOI
  30. [32]Johnson DA Hacker JF 3rd Benjamin SB Ciarleglio CA Chobanian SJ Van Ness MM Percutaneous endoscopic gastrostomy effects on gastroesophageal reflux and the lower esophageal sphincter Am J Gastroenterol. 82 7 1987 622 624 PubMed PMID: 3605022 3605022
  31. [33]Razeghi S Lang T Behrens R Influence of percutaneous endoscopic gastrostomy on gastroesophageal reflux: a prospective study in 68 children J Pediatr Gastroenterol Nutr. 35 1 2002 27 30 PubMed PMID: 12142806 10.1097/00005176-200207000-00007 12142806 · DOI
  32. [34]Anderson MR O'Connor M Mayer P O'Mahony D Woodward J Kane K The nasal loop provides an alternative to percutaneous endoscopic gastrostomy in highrisk dysphagic stroke patients Clinical Nutrition 23 4 2004 501 506 PubMed PMID: 15297085 10.1016/j.clnu.2003.09.008 15297085 · DOI · Paper page
  33. [35]Alvarez-Fernandez B Garcia-Ordonez MA Martinez-Manzanares C Gomez-Huelgas R Survival of a cohort of elderly patients with advanced dementia: nasogastric tube feeding as a risk factor for mortality International Journal of Geriatric Psychiatry 20 4 2005 363 370 PubMed PMID: 15799075 10.1002/gps.1299 15799075 · DOI
  34. [36]Wakabayashi H Sashika H Malnutrition is associated with poor rehabilitation outcome in elderly inpatients with hospital-associated deconditioning a prospective cohort study Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 2013 24213734
  35. [37]Kaiser MJ Bauer JM Ramsch C Uter W Guigoz Y Cederholm T Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment J Am Geriatr Soc. 58 9 2010 1734 1738 PubMed PMID: 20863332 10.1111/j.1532-5415.2010.03016.x 20863332 · DOI · Paper page
  36. [38]Serra-Prat M Palomera M Gomez C Sar-Shalom D Saiz A Montoya JG Oropharyngeal dysphagia as a risk factor for malnutrition and lower respiratory tract infection in independently living older persons: a population-based prospective study Age Ageing. 41 3 2012 376 381 PubMed PMID: 22311895 10.1093/ageing/afs006 22311895 · DOI
  37. [39]Dhandapani M Dhandapani S Agarwal M Mahapatra AK Pressure ulcer in patients with severe traumatic brain injury: significant factors and association with neurological outcome J Clin Nurs. 2013 24112115
  38. [40]Murphy LM Lipman TO Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia Arch Intern Med. 163 11 2003 1351 1353 PubMed PMID: 12796072 10.1001/archinte.163.11.1351 12796072 · DOI

Cited by

Sorted by citations

Authors
Jaafar, M. H., Mahadeva, S., Morgan, K., & Tan, M. P.
Affiliations
University of Malaya (MY)
Corresponding author
Tan, M.P.
ORCID
Venue
The Journal of nutrition, health and aging
Publisher
Elsevier BV
Published
2015-02
Volume
19
Issue
2
Pages
190-197
ISSN
1279-7707 (ISSN-L)
DOI
10.1007/s12603-014-0527-z
PMC
PMC12877540
OpenAlex
W2054770276
Cited by
44
References
0
Citations by year
2026: 3 · 2025: 5 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 5 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 1 · 2016: 4 · 2015: 2
FWCI
0.47
Type
journal article
Language
en
Open access
Licence
Locations
  • The journal of nutrition health & aging (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
percutaneous endoscopic gastrostomy, nasogastric tube feeding, dysphagia, older adults, pneumonia risk, feeding complications, mortality, nutritional outcomes, enteral nutrition
MeSH terms
Aged, Clinical Trials as Topic, Deglutition Disorders, Enteral Nutrition, Gastrostomy, Humans, Intubation, Gastrointestinal, Middle Aged, Pneumonia, Geriatric Assessment, Nutrition Assessment, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review