Endoscopy versus fluoroscopy for the placement of postpyloric nasoenteric tubes in critically ill patients: A meta-analysis of randomized controlled trials

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• 作者：Youfeng Zhu^a ; ^{151276953@qq.com" class="auth_mail" title="E-mail the corresponding author} ; Haiyan Yin^a ; ^{yinhaiyan1867@126.com" class="auth_mail" title="E-mail the corresponding author} ; Rui Zhang^a ; ^{63281796@qq.com" class="auth_mail" title="E-mail the corresponding author} ; Xiaoling Ye^a ; ^{1718768452@qq.com" class="auth_mail" title="E-mail the corresponding author} ; Jianrui Wei^b ; ^{Jianruiw@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Critically ill patients ; Postpyloric ; Enteral nutrition ; Endoscopy ; Fluoroscopy ; Meta-analysis
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：33
• 期：Complete
• 页码：207-212
• 全文大小：639 K

文摘

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.