Percutaneous endoscopic gastrostomy versus nasogastric tube feeding in post-stroke dysphagia: a meta-analysis study.

BACKGROUND

Post-stroke dysphagia affects half of survivors and leads to serious complications. Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are primary feeding methods, yet their comparative effectiveness remains controversial.

OBJECTIVE

This meta-analysis compared PEG versus NGT feeding in post-stroke dysphagia regarding mortality, pneumonia, nutritional outcomes, and length of stay (LOS). Methods Following PRISMA guidelines, we searched MEDLINE, EMBASE, Cochrane Library, and PubMed. Ten studies (N=1,416) were included. Pooled risk ratios (RR) and mean differences (MD) were calculated using random-effects models in R-4.2.1. Quality was assessed via the Downs and Black checklist.

RESULTS

Compared to NGT, PEG showed a 30% reduction in mortality risk (RR 0.70; 95% CI 0.50-0.98; p = 0.039); however, this was not significant in sensitivity analysis restricted to RCTs. PEG also showed a 47% reduction in pneumonia risk (RR 0.53; 95% CI 0.42-0.67; p < 0.001). Nutrition favored PEG, with significantly higher serum albumin (MD +4.56 g/L; 95% CI 1.25-7.87; p = 0.007). No significant differences occurred in mid-arm circumference (p = 0.16) or LOS (p = 0.34). Heterogeneity was moderate for mortality (I² = 47.5%) and low for pneumonia (I² = 0%).

CONCLUSION

PEG significantly reduces pneumonia risk and may improve nutritional outcomes compared to NGT. Mortality benefits were not confirmed in RCT-only analyses, suggesting possible confounding. Feeding decisions should balance benefits, procedural risks, and patient-specific factors, emphasizing shared decision-making. Further high-quality RCTs are warranted.