The Complications and Recovery of Swallowing Function After Percutaneous Endoscopic Feeding Tubes: A Systematic Comparative Analysis

Introduction: The 3 commonly used types of percutaneous endoscopic feeding tubes are gastrostomy tube (PEG), jejunostomy tube (PEJ), and gastrojejunostomy tube (PEG-J). There is a tremendous overlap in their indications, contraindications, and overall characteristics. Patients often need multiple trials with various feeding tubes before the identification of their suitability. This study aims to compare different percutaneous endoscopic feeding tubes outcomes and determine its clinical significance. Methods: A scoping review was conducted using PubMed to analyze studies comparing PEG, PEJ, and PEG-J tubes. Baseline characteristics, clinical indications, complications, tube duration, swallowing function recovery, antibiotic prophylaxis use, and tube-related mortality were examined. The data was independently reviewed by 3 authors. Weight-adjusted descriptive analysis was performed, and a pooled analysis with the Chi-squared test determined clinical significance (P ≤ 0.05). Results: 22 studies (7 randomized clinical trials, 8 retrospective cohorts, 7 prospective cohorts) included 1597 patients (691 PEG, 478 PEJ, 428 PEG-J). Median age was 61, and neurological impairment was the most common indication (55%). Hypertension and diabetes were the most reported comorbidities (11% and 10% respectively). Antibiotic prophylaxis usage was 54% (PEG), 44% (PEJ), and 11% (PEG-J). Complication rates were 27% (PEG), 36% (PEJ), and 38% (PEG-J). Infections were the most common complication, especially in PEJ (34% vs. 8% PEG vs. 4% PEG-J; P-value = < 0.0001) with a 94% weighted average for cases receiving antibiotic prophylaxis. Average follow-up and tube placement duration was 6.5 months. Swallowing function recovery was highest in PEG-J tubes (14% vs. 9% PEG vs. 7% PEJ; P-value = < 0.001533) (Figure 1, Table 1). Conclusion: This study highlights the clinical significance of PEJ-related infections. However, the association with infections may be influenced by variations in antibiotic prophylaxis guidelines across studies. Further investigation is needed to address this association and PEJ-related infections. Additionally, the notable rate of PEG-J cases resuming oral diet should be emphasized, while considering the higher dislodgment rate in this group. More studies are needed to clarify the potential benefits of using PEG-J for temporary artificial feeding indications.Figure 1.: Patients Resuming Oral Diet. Table 1. - Comparison of Feeding Tubes Infections rate and Complications Baselines characters Gender (Male): 59% Median age: 61 Highest comorbidities: HTN 11% DM 10% Variable Feeding tube PEG (691) PEJ (478) PEG-J (428) Infections [P-value = < 0.0001] * 8% 34% 4% Tube blockage [P-value = < 0.0001] 9% 4% 20% Tube Dislodgement/Dislocation [P-value = < 0.0001] 3% 2% 26%