Is Percutaneous Endoscopic Gastrostomy Tube Feeding Beneficial for Improving Survival in Patients With Dementia? A Systematic Review and Meta-Analysis of Current Pieces of Evidence
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Abstract
Dementia is a progressive, disabling neurogenic disease that results in serious nutritional deficiencies included dysphagia, malnutrition, and weight loss. The Percutaneous Endoscopic Gastrostomy (PEG) is a long-term enteral feeding method that is routinely used in demented patients with poor food intake as a standard protocol. However, most of the pieces of evidence have not shown the beneficial effects of PEG feeding on complications or survival rates in these patients. Some studies have even reported an increase in mortality. The current systematic review and meta-analysis aimed to evaluate the mortality rate and survival in primary demented patients with PEG. A systematic search was conducted on Pubmed and Scopus databases up to Aug 2019. The data were reviewed according to the Cochrane handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE). Based on the random-effects model, the mortality rate and median survival were expressed as risk ratio and weighted mean difference (WMD) and 95% CI, respectively. Among 13 included studies, PEG insertion in patients with primary dementia has no significant effect on 30-day, 90-day, 180-day, 1-year, and 2- year mortality rate or median survival (WMD: 9.77; 95% CI: -22.43 to 41.98; P=0.55). It seems that nasogastric tube (NGT) feeding in compared to PEG in this population is more effective. In conclusion, further prospective studies are needed for comprehensive evaluation of mortality or survival regarding comorbidities, underlying disease, cognitive and physical performance, and nutritional problems in demented patients.
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2. Douglas JW, Lawrence JC, Turner LW. Social ecological perspectives of tube-feeding older adults with advanced dementia: A systematic literature review. J Nutr Gerontol Geriatr 2017;36:1-17.
3. Sanders DS, Leeds JS, Drew K. The role of percutaneous endoscopic gastrostomy in patients with dementia. Br J Nurs 2008;17:588-94.
4. Dunne A. Nutrition and dementia. Nurs Resid Care 2010;12:112-6.
5. Chung AM. Percutaneous gastrostomy feeding tubes in end stage dementia: don't “just do it”. Can Assoc Radiol J 2012;63:S5-6.
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10. Panic N, Leoncini E, De Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PloS one 2013;8:e83138.
11. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008-12.
12. Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2011.
13. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons; 2011.
14. Dudley WN, Wickham R, Coombs N. An introduction to survival statistics: Kaplan-Meier analysis. J Adv Pract Oncol 2016;7:91-100.
15. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
16. Nair S, Hertan H, Pitchumoni C. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia. Am J Gastroenterol 2000;95:133-6.
17. Sanders DS, Carter M, D'silva J, James G, Bolton R, Bardhan K. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472-5.
18. Dwolatzky T, Berezovski S, Friedmann R, Paz J, Clarfield A, Stessman J, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr 2001;20:535-40.
19. Meier DE, Ahronheim JC, Morris J, Baskin-Lyons S, Morrison RS. High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding. Arch Intern Med 2001;161:594-9.
20. Paillaud E, Bories PN, Merlier I, Richardet JP, Jeanfaivre V, Campillo B. Prognosis factors of short and long-term survival in elderly hospitalized patients after percutaneous endoscopic gastrostomy. Gastroenterol Clin Biol 2002;26:443-7.
21. Murphy LM, Lipman TO. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. Arch Intern Med 2003;163:1351-3.
22. Rimon E, Kagansky N, Levy S. Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups. Age Ageing 2005;34:353-7.
23. Malmgren A, Hede GW, Karlström B, Cederholm T, Lundquist P, Wirén M, et al. Indications for percutaneous endoscopic gastrostomy and survival in old adults. Food Nutr Res 2011;55:6037.
24. Kumagai R, Kubokura M, Sano A, Shinomiya M, Ohta S, Ishibiki Y, et al. Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia. Psychiatry Clin Neurosci 2012;66:418-22.
25. Atencio DP, Blanco Pérez ÁG, Otero Regino W. Percutaneous Endoscopic Gastrostomy in elderly, indications, safety and outcomes. Revista Colombiana de Gastroenterologia 2015;30:3-10.
26. Takayama K, Hirayama K, Hirao A, Kondo K, Hayashi H, Kadota K, et al. Survival times with and without tube feeding in patients with dementia or psychiatric diseases in Japan. Psychogeriatrics 2017;17:453-9.
27. Tomioka H, Yamashita S, Mamesaya N, Kaneko M. Percutaneous endoscopic gastrostomy for aspiration pneumonia: A 10-year single-center experience. Respir Investig 2017;55:203-11.
28. Ticinesi A, Nouvenne A, Lauretani F, Prati B, Cerundolo N, Maggio M, et al. Survival in older adults with dementia and eating problems: To PEG or not to PEG? Clin Nutr 2016;35:1512-6.
29. Farrag K, Shastri YM, Beilenhoff U, Aksan A, Stein J. Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management. BMJ 2019;364:k5311.
30. Löser C, Aschl G, Hebuterne X, Mathus-Vliegen E, Muscaritoli M, Niv Y, et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005;24:848-61.
31. Sarkar P, Cole A, Scolding NJ, Rice CM. Percutaneous endoscopic gastrostomy tube insertion in neurodegenerative disease: a retrospective study and literature review. Clin Endosc 2017;50:270-8.
32. Löser C. Clinical aspects of long-term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). J Nutr Health Aging 2000;4:47-50.
33. Delegge MH. Percutaneous endoscopic gastrostomy in the dementia patient: helpful or hindering? Am J Gastroenterol 2008;103:1018-20.
34. Teno JM, Gozalo PL, Mitchell SL, Kuo S, Rhodes RL, Bynum JP, et al. Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc 2012;60:1918-21.
35. Teno JM, Gozalo P, Mitchell SL, Kuo S, Fulton AT, Mor V. Feeding tubes and the prevention or healing of pressure ulcers. Arch Intern Med 2012;172:697-701.
36. Yang B, Shi X. Percutaneous endoscopic gastrostomy versus fluoroscopic gastrostomy in amyotrophic lateral sclerosis (ALS) sufferers with nutritional impairment: A meta-analysis of current studies. Oncotarget 2017;8:102244-53.
37. Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care 2016;20:117.
38. Gomes Jr CA, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev 2015;2015:CD008096.
39. Mitchell SL, Miller SC, Teno JM, Kiely DK, Davis RB, Shaffer ML. Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines. JAMA 2010;304:1929-35.
40. Gingold-Belfer R, Weiss A, Geller A, Sapoznikov B, Beloosesky Y, Morag-Koren N, et al. Increasing serum albumin level shortly after gastrostomy tube insertion predicts longer survival in elderly patients with dementia. J Clin Gastroenterol 2017;51:339-44.
41. Higaki F, Yokota O, Ohishi M. Factors predictive of survival after percutaneous endoscopic gastrostomy in the elderly: is dementia really a risk factor? Am J Gastroenterol 2008;103:1011-6
2. Douglas JW, Lawrence JC, Turner LW. Social ecological perspectives of tube-feeding older adults with advanced dementia: A systematic literature review. J Nutr Gerontol Geriatr 2017;36:1-17.
3. Sanders DS, Leeds JS, Drew K. The role of percutaneous endoscopic gastrostomy in patients with dementia. Br J Nurs 2008;17:588-94.
4. Dunne A. Nutrition and dementia. Nurs Resid Care 2010;12:112-6.
5. Chung AM. Percutaneous gastrostomy feeding tubes in end stage dementia: don't “just do it”. Can Assoc Radiol J 2012;63:S5-6.
6. Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev 2009;2009:CD007209.
7. Inanc Y, Gokce M, Tuncel D, Inanc Y, Ozcekic Demirhan S, Bavli S. Percutaneous endoscopic gastrostomy in neurology intensive care unit. Int J Surg Med 2018;4:33-5.
8. Goldberg LS, Altman KW. The role of gastrostomy tube placement in advanced dementia with dysphagia: a critical review. Clin Interv Aging 2014;9:1733-9.
9. Salomon ALR, Novaes MCG. Outcomes of enteral nutrition for patients with advanced dementia: A systematic review. J Nutr Health Aging 2015;19:169-77.
10. Panic N, Leoncini E, De Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PloS one 2013;8:e83138.
11. Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA 2000;283:2008-12.
12. Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute; 2011.
13. Higgins JP, Green S. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons; 2011.
14. Dudley WN, Wickham R, Coombs N. An introduction to survival statistics: Kaplan-Meier analysis. J Adv Pract Oncol 2016;7:91-100.
15. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5:13.
16. Nair S, Hertan H, Pitchumoni C. Hypoalbuminemia is a poor predictor of survival after percutaneous endoscopic gastrostomy in elderly patients with dementia. Am J Gastroenterol 2000;95:133-6.
17. Sanders DS, Carter M, D'silva J, James G, Bolton R, Bardhan K. Survival analysis in percutaneous endoscopic gastrostomy feeding: a worse outcome in patients with dementia. Am J Gastroenterol 2000;95:1472-5.
18. Dwolatzky T, Berezovski S, Friedmann R, Paz J, Clarfield A, Stessman J, et al. A prospective comparison of the use of nasogastric and percutaneous endoscopic gastrostomy tubes for long-term enteral feeding in older people. Clin Nutr 2001;20:535-40.
19. Meier DE, Ahronheim JC, Morris J, Baskin-Lyons S, Morrison RS. High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding. Arch Intern Med 2001;161:594-9.
20. Paillaud E, Bories PN, Merlier I, Richardet JP, Jeanfaivre V, Campillo B. Prognosis factors of short and long-term survival in elderly hospitalized patients after percutaneous endoscopic gastrostomy. Gastroenterol Clin Biol 2002;26:443-7.
21. Murphy LM, Lipman TO. Percutaneous endoscopic gastrostomy does not prolong survival in patients with dementia. Arch Intern Med 2003;163:1351-3.
22. Rimon E, Kagansky N, Levy S. Percutaneous endoscopic gastrostomy; evidence of different prognosis in various patient subgroups. Age Ageing 2005;34:353-7.
23. Malmgren A, Hede GW, Karlström B, Cederholm T, Lundquist P, Wirén M, et al. Indications for percutaneous endoscopic gastrostomy and survival in old adults. Food Nutr Res 2011;55:6037.
24. Kumagai R, Kubokura M, Sano A, Shinomiya M, Ohta S, Ishibiki Y, et al. Clinical evaluation of percutaneous endoscopic gastrostomy tube feeding in Japanese patients with dementia. Psychiatry Clin Neurosci 2012;66:418-22.
25. Atencio DP, Blanco Pérez ÁG, Otero Regino W. Percutaneous Endoscopic Gastrostomy in elderly, indications, safety and outcomes. Revista Colombiana de Gastroenterologia 2015;30:3-10.
26. Takayama K, Hirayama K, Hirao A, Kondo K, Hayashi H, Kadota K, et al. Survival times with and without tube feeding in patients with dementia or psychiatric diseases in Japan. Psychogeriatrics 2017;17:453-9.
27. Tomioka H, Yamashita S, Mamesaya N, Kaneko M. Percutaneous endoscopic gastrostomy for aspiration pneumonia: A 10-year single-center experience. Respir Investig 2017;55:203-11.
28. Ticinesi A, Nouvenne A, Lauretani F, Prati B, Cerundolo N, Maggio M, et al. Survival in older adults with dementia and eating problems: To PEG or not to PEG? Clin Nutr 2016;35:1512-6.
29. Farrag K, Shastri YM, Beilenhoff U, Aksan A, Stein J. Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management. BMJ 2019;364:k5311.
30. Löser C, Aschl G, Hebuterne X, Mathus-Vliegen E, Muscaritoli M, Niv Y, et al. ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG). Clin Nutr 2005;24:848-61.
31. Sarkar P, Cole A, Scolding NJ, Rice CM. Percutaneous endoscopic gastrostomy tube insertion in neurodegenerative disease: a retrospective study and literature review. Clin Endosc 2017;50:270-8.
32. Löser C. Clinical aspects of long-term enteral nutrition via percutaneous endoscopic gastrostomy (PEG). J Nutr Health Aging 2000;4:47-50.
33. Delegge MH. Percutaneous endoscopic gastrostomy in the dementia patient: helpful or hindering? Am J Gastroenterol 2008;103:1018-20.
34. Teno JM, Gozalo PL, Mitchell SL, Kuo S, Rhodes RL, Bynum JP, et al. Does feeding tube insertion and its timing improve survival? J Am Geriatr Soc 2012;60:1918-21.
35. Teno JM, Gozalo P, Mitchell SL, Kuo S, Fulton AT, Mor V. Feeding tubes and the prevention or healing of pressure ulcers. Arch Intern Med 2012;172:697-701.
36. Yang B, Shi X. Percutaneous endoscopic gastrostomy versus fluoroscopic gastrostomy in amyotrophic lateral sclerosis (ALS) sufferers with nutritional impairment: A meta-analysis of current studies. Oncotarget 2017;8:102244-53.
37. Elke G, van Zanten AR, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care 2016;20:117.
38. Gomes Jr CA, Andriolo RB, Bennett C, Lustosa SA, Matos D, Waisberg DR, et al. Percutaneous endoscopic gastrostomy versus nasogastric tube feeding for adults with swallowing disturbances. Cochrane Database Syst Rev 2015;2015:CD008096.
39. Mitchell SL, Miller SC, Teno JM, Kiely DK, Davis RB, Shaffer ML. Prediction of 6-month survival of nursing home residents with advanced dementia using ADEPT vs hospice eligibility guidelines. JAMA 2010;304:1929-35.
40. Gingold-Belfer R, Weiss A, Geller A, Sapoznikov B, Beloosesky Y, Morag-Koren N, et al. Increasing serum albumin level shortly after gastrostomy tube insertion predicts longer survival in elderly patients with dementia. J Clin Gastroenterol 2017;51:339-44.
41. Higaki F, Yokota O, Ohishi M. Factors predictive of survival after percutaneous endoscopic gastrostomy in the elderly: is dementia really a risk factor? Am J Gastroenterol 2008;103:1011-6
| Files | ||
| Issue | Vol 60, No 1 (2022) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/acta.v60i1.8322 | |
| Keywords | ||
| Dementia Mortality Survival Nutrition support Percutaneous endoscopic gastrostomy (PEG) | ||
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How to Cite
1.
Raeesi S, Hashemi R, Vahabi Z, Abdolahi M, Sedighiyan M. Is Percutaneous Endoscopic Gastrostomy Tube Feeding Beneficial for Improving Survival in Patients With Dementia? A Systematic Review and Meta-Analysis of Current Pieces of Evidence. Acta Med Iran. 2022;60(1):5-17.
