Summary of findings for the main comparison. Percutaneous endoscopic gastrostomy compared with nasogastric tube feeding for adults with swallowing disturbances.
| Percutaneous endoscopic gastrostomy compared with nasogastric tube feeding for adults with swallowing disturbances | ||||||
| Patient or population: adult patients with swallowing disturbances Settings: in‐patient Intervention: percutaneous endoscopic gastrostomy Comparison: nasogastric tube feeding | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Nasogastric tube feeding | Percutaneous endoscopic gastrostomy | |||||
| Treatment failure Feeding interruption, blocking or leakage of the tube, non‐adherence Follow‐up: 0 to 6 months | Study population | RR 0.18 (0.05 to 0.59) | 408 (8 studies) | ⊕⊕⊝⊝ low1,3 | The subgroup of stroke/neurological diseases was associated with a lower risk of intervention failure compared with the subgroup composed of mixed diseases. Favours PEG |
|
| 391 per 1000 | 70 per 1000 (20 to 231) | |||||
| Low | ||||||
| 375 per 1000 | 30 per 1000 (7 to 124) | |||||
| High | ||||||
| 319 per 1000 | 102 per 1000 (26 to 421) | |||||
| Mortality irrespective of follow‐up time Follow‐up: 0 to 6 months | 366 per 1000 | 315 per 1000 (212 to 469) | RR 0.86 (0.58 to 1.28) | 644 (9 studies) | ⊕⊝⊝⊝ very low1,2,3 | Favours neither PEG nor NGT. |
| Pneumonia irrespective of follow‐up time Follow‐up: 0 to 6 months | 415 per 1000 | 291 per 1000 (24 to 45) | RR 0.7 (0.46 to 1.06) | 645 (7 studies) | ⊕⊕⊝⊝ low1,3 | Favours neither PEG nor NGT. |
| Adverse events irrespective of follow‐up time Follow‐up: 0‐17 months | 458 per 1000 | 380 per 1000 (234 to 614) | RR 0.83 (0.51 to 1.34) | 597 (6 studies) | ⊕⊕⊕⊝ moderate1,3 | Favours neither PEG nor NGT. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Design limitation (risk of bias), unclear sequence generation, allocation concealment and loss to follow‐up. 2 Relatively few participants and few events and/or wide confidence intervals 3 Widely differing estimates of the treatment effect (i.e. heterogeneity or variability in results) across studies