1. Endoscopy versus fluoroscopy for the placement of postpyloric nasoenteric tubes in critically ill patients: A meta-analysis of randomized controlled trials
- Author
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Youfeng Zhu, Rui Zhang, Xiaoling Ye, Jianrui Wei, and Haiyan Yin
- Subjects
medicine.medical_specialty ,Critical Care ,Critical Illness ,Perforation (oil well) ,MEDLINE ,Nutritional Status ,Critical Care and Intensive Care Medicine ,law.invention ,03 medical and health sciences ,Enteral Nutrition ,0302 clinical medicine ,Randomized controlled trial ,law ,Gastroscopy ,Humans ,Medicine ,Fluoroscopy ,Intubation, Gastrointestinal ,Randomized Controlled Trials as Topic ,medicine.diagnostic_test ,business.industry ,030208 emergency & critical care medicine ,Surgery ,Endoscopy ,Parenteral nutrition ,Strictly standardized mean difference ,Meta-analysis ,030211 gastroenterology & hepatology ,business - Abstract
Introduction Early postpyloric nasoenteric nutrition is considered an accepted method of nutritional support in critically ill patients. Both endoscopy and fluoroscopy placement of postpyloric nasoenteric tubes (PNTs) have the highest percentages of placement success rate. We aimed to evaluate the differences in efficacy and safety between endoscopy and fluoroscopy methods for the placement of PNTs in critically ill patients. Method We searched MEDLINE, Embase, and electronic databases of Cochrane Central Register of Controlled Trials. We included randomized controlled trials comparing endoscopy and fluoroscopy placement of PNTs in critically ill patients. Two reviewers assessed the quality of each study and collected data independently. We performed the meta-analysis with Cochrane Collaboration RevMan 5.3. Results Three randomized controlled trials involving 243 patients were included. There were no significant differences in the placement success rate (RR, 0.99; 95% CI, 0.93, 1.06; z = 0.20, P = .84,) or procedure time (standardized mean difference, − 0.08; 95% CI, − 6.93, 6.77; z = 0.02, P = .98) between the 2 groups. No severe complications (digestive tract hemorrhage, perforation, respiratory problems, hemodynamic instability, or death) were noted in the three studies. There was a slight difference in the incidence of minor complications (RR, 8.12; 95% CI, 1.07, 61.53; z = 2.03, P = .04) between the 2 groups. Conclusions Endoscopy and fluoroscopy placement of PNTs can be accurately and safely performed in critically ill patients. Endoscopy may be at least equally as safe as fluoroscopy for the placement of PNTs.
- Published
- 2016