Is Percutaneous Endoscopic Gastrostomy (PEG) tube feeding Beneficial for Improving Survival in Patients with Dementia? A systematic review and meta- analysis of current evidences

Abstract

Background Dementia is a progressive disabling neurogenic disease resulted in serious nutritional deficiencies included dysphagia, malnutrition and weight loss. The Percutaneous Endoscopic Gastrostomy (PEG) which is a long-term enteral feeding method that routinely use in demented patients with poor food intake as a standard protocol. However, most of the evidences have not shown 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.Methods A systemically search conducted on Pubmed and Scopus databases up to Aug 2019 without language restriction. The data were reviewed according to Cochrane handbook and preferred reporting items for systematic reviews and meta-analyses (PRISMA) and meta-analysis of observational studies in epidemiology (MOOSE). Based on random-effects model, mortality rate and median survival were expressed as risk ratio and weighted mean difference (WMD) and 95% CI respectively.Results 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 naso-gastric tube (NGT) feeding in compared to PEG in this population is more effective.Conclusion Further prospective studies are needed to comprehensive evaluation of mortality or survival regarding to comorbidities, underlying disease, cognitive and physical performance and nutritional problems in demented patients.