Electromagnetic-guided versus endoscopic placement of post-pyloric feeding tubes: a systematic review and meta-analysis of randomised controlled trials

Abstract Background Current evidence supporting the utility of electromagnetic (EM)-guided method as the preferred technique for post-pyloric feeding tube placement is limited. We conducted a meta-analysis to compare the performance of EM-guided versus endoscopic placement. Methods We searched several databases for all randomised controlled trials evaluating the EM-guided vs. endoscopic placement of post-pyloric feeding tubes up to 28 July 2020. Primary outcome was procedure success rate. Secondary outcomes included reinsertion rate, number of attempts, placement-related complications, tube-related complications, insertion time, total procedure time, patient discomfort, recommendation scores, length of hospital stay, mortality, and total costs. Results Four trials involving 536 patients were qualified for the final analysis. There was no difference between the two groups in procedure success rate (RR 0.97; 95% CI 0.91–1.03), reinsertion rate (RR 0.84; 95% CI 0.59–1.20), number of attempts (WMD − 0.23; 95% CI − 0.99–0.53), placement-related complications (RR 0.78; 95% CI 0.41–1.49), tube-related complications (RR 1.08; 95% CI 0.82–1.44), total procedure time (WMD − 18.09 min; 95% CI − 38.66–2.47), length of hospital stay (WMD 1.57 days; 95% CI − 0.33–3.47), ICU mortality (RR 0.80; 95% CI 0.50–1.29), in-hospital mortality (RR 0.87; 95% CI 0.59–1.28), and total costs (SMD − 1.80; 95% CI − 3.96–0.36). The EM group was associated with longer insertion time (WMD 4.3 min; 95% CI 0.2–8.39), higher patient discomfort level (WMD 1.28; 95% CI 0.46–2.1), and higher recommendation scores (WMD 1.67; 95% CI 0.24–3.10). Conclusions No significant difference was found between the two groups in efficacy, safety, and costs. Further studies are needed to confirm our findings. Systematic review registration PROSPERO (CRD42020172427)

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Electromagnetic-Guided Versus Endoscopic Placement of Nasoenteral Feeding Tubes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

10.21203/rs.3.rs-60933/v1 ◽

2020 ◽

Author(s):

Yaping Wei ◽

Zheng Jin ◽

Ying Zhu ◽

Wei Hu

Keyword(s):

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Procedure Time ◽

Feeding Tubes ◽

Randomized Controlled ◽

Total Procedure Time ◽

Nasoenteral Feeding ◽

Endoscopic Placement ◽

Total Procedure

Abstract Objectives: Current evidence supporting the utility of electromagnetic (EM)-guided method as the preferred technique for nasoenteral feeding tube placement is limited. We conducted a meta-analysis to compare the performance of EM-guided versus endoscopic placement.Methods: We searched several databases for all randomized controlled trials evaluating the EM-guided vs. endoscopic placement of nasoenteral feeding tubes up to 28 July 2020. Primary outcome was procedure success rate. Secondary outcomes included reinsertion rate, number of attempts, placement-related complications, tube-related complications, insertion time, total procedure time, patient discomfort, recommendation scores, length of hospital stay, mortality, and total costs. Results: Four trials involving 536 patients were qualified for the final analysis. There was no difference between the two groups in procedure success rate (RR 0.97; 95% CI: 0.91-1.03), reinsertion rate (RR 0.84; 95% CI: 0.59-1.20), number of attempts (WMD -0.23; 95% CI: -0.99-0.53), placement-related complications (RR 0.78; 95% CI: 0.41-1.49), tube-related complications (RR 1.08; 95% CI: 0.82-1.44), total procedure time (WMD -18.09; 95% CI: -38.66-2.47), length of hospital stay (WMD 1.57; 95% CI: -0.33-3.47), ICU mortality (RR 0.80; 95% CI: 0.50-1.29), in-hospital mortality (RR 0.87; 95% CI: 0.59-1.28), and total costs (SMD -1.80; 95% CI: -3.96-0.36). The EM group was associated with longer insertion time (WMD 4.3; 95% CI: 0.2-8.39), higher patient discomfort level (WMD 1.28; 95% CI: 0.46-2.1), and higher recommendation scores (WMD 1.67; 95% CI: 0.24-3.10).Conclusions: EM-guided placement showed similar efficacy, safety and cost-effectiveness when compared with endoscopic placement of nasoenteral feeding tubes.

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Interventions for oropharyngeal dysphagia in acute and critical care: a protocol for a systematic review and meta-analysis

Systematic Reviews ◽

10.1186/s13643-019-1196-0 ◽

2019 ◽

Vol 8 (1) ◽

Cited By ~ 4

Author(s):

Sallyanne Duncan ◽

Jennifer Mc Gaughey ◽

Richard Fallis ◽

Daniel F. McAuley ◽

Margaret Walshe ◽

...

Keyword(s):

Systematic Review ◽

Clinical Trials ◽

Critical Care ◽

Acute Care ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Oropharyngeal Dysphagia ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Randomised Controlled

Abstract Background Oropharyngeal dysphagia or swallowing difficulties are common in acute care and critical care, affecting 47% of hospitalised frail elderly, 50% of acute stroke patients and approximately 62% of critically ill patients who have been intubated and mechanically ventilated for prolonged periods. Complications of dysphagia include aspiration leading to chest infection and pneumonia, malnutrition, increased length of hospital stay and re-admission to hospital. To date, most dysphagia interventions in acute care have been tested with acute stroke populations. While intervention studies in critical care have been emerging since 2015, they are limited and so there is much to learn about the type, the delivery and the intensity of treatments in this setting to inform future clinical trials. The aim of this systematic review is to summarise the evidence regarding the relationship between dysphagia interventions and clinically important patient outcomes in acute and critical care settings. Methods We will search MEDLINE, EMBASE, CENTRAL, Web of Science, CINAHL and clinical trial registries from inception to the present. We will include studies conducted with adults in acute care settings such as acute hospital wards or units or intensive care units and critical care settings. Studies will be restricted to randomised controlled trials and quasi-randomised controlled trials comparing a new dysphagia intervention with usual care or another intervention. The main outcomes that will be collected include length of time taken to return to oral intake, change in incidence of aspiration and pneumonia, nutritional status, length of hospital stay and quality of life. Key intervention components such as delivery, intensity, acceptability, fidelity and adverse events associated with such interventions will be collected to inform future clinical trials. Two independent reviewers will assess articles for eligibility, data extraction and quality appraisal. A meta-analysis will be conducted as appropriate. Discussion No systematic review has attempted to summarise the evidence for oropharyngeal dysphagia interventions in acute and critical care. Results of the proposed systematic review will inform practice and the design of future clinical trials. Systematic review registration PROSPERO CRD 42018116849 (http://www.crd.york.ac.uk/PROSPERO/)

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EP.TH.770Upgrading the level of evidence regarding Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: Meta-analysis of randomised controlled trials

British Journal of Surgery ◽

10.1093/bjs/znab309.083 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Shahin Hajibandeh ◽

Shahab Hajibandeh ◽

Rajnish Mankotia ◽

Rajeev Peravali

Keyword(s):

Postoperative Pain ◽

Anastomotic Leak ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Right Hemicolectomy ◽

Controlled Trials ◽

Procedure Time ◽

Perioperative Morbidity ◽

Laparoscopic Right Hemicolectomy ◽

Randomised Controlled

Abstract Objectives To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Methods We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length. Future research may provide stronger evidence in favour of an intervention.

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98 Intracorporeal Versus Extracorporeal Anastomosis in Laparoscopic Right Hemicolectomy: Meta-Analysis of Randomised Controlled Trials

British Journal of Surgery ◽

10.1093/bjs/znab259.604 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

M Qayum ◽

G Nawaz ◽

S Hajibandeh ◽

S Hajibandeh

Keyword(s):

Postoperative Pain ◽

Anastomotic Leak ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Right Hemicolectomy ◽

Controlled Trials ◽

Procedure Time ◽

Perioperative Morbidity ◽

Laparoscopic Right Hemicolectomy ◽

Randomised Controlled

Abstract Aim To evaluate comparative outcomes of intracorporeal (ICA) and extracorporeal (ECA) anastomosis in laparoscopic right hemicolectomy. Method We conducted a systematic search of electronic databases and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Overall perioperative morbidity, anastomotic leak, surgical site infection (SSI), paralytic ileus, bleeding, postoperative pain within 5 days, conversion to an open procedure, length of incision and procedure time were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models. Results We identified 4 randomised controlled trials reporting a total of 399 patients evaluating outcomes of ICA (n = 199) and ECA (n = 200) in laparoscopic right hemicolectomy. The ICA was associated with significantly shorter length of incision (MD:-1.82, P < 0.00001), lower postoperative pain score on day 2 (MD:-0.69, P = 0.0007), day 3 (MD:-0.80, P = 0.02), day 4 (MD:-0.83, P = 0.01) and day 5 (MD:-0.49, P < 0.00001) when compared to ECA. Moreover, it was associated with significantly shorter length of hospital stay (MD:-0.27, p = 0.03). However, there was no significant difference in overall perioperative morbidity (RR:0.79, P = 0.47), anastomotic leak (RR:1.29, P = 0.65), SSI (RR:0.61, P = 0.42), bleeding (RR:0.70, P = 0.71), ileus (RR:0.60, P = 0.45), conversion to open (RD:-0.02, P = 0.45), number of harvested lymph nodes (MD:0.82, p = 0.06), and procedure time (MD:16.04, p = 0.06) between two groups. Conclusions The meta-analysis of level 1 evidence demonstrated that ICA and ECA have comparable perioperative outcomes in laparoscopic right colectomy although the former may be associated with less postoperative pain probably due to shorter incision length.

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The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-019-04507-3 ◽

2020 ◽

Vol 24 (11) ◽

pp. 2643-2653 ◽

Cited By ~ 3

Author(s):

Farah Roslan ◽

Anisa Kushairi ◽

Laura Cappuyns ◽

Prita Daliya ◽

Alfred Adiamah

Keyword(s):

Colorectal Surgery ◽

Standard Care ◽

Randomised Controlled Trials ◽

Postoperative Ileus ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Chewing Gum ◽

Controlled Trials ◽

Sham Feeding ◽

Randomised Controlled

Abstract Background Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of the multimodal approaches to expedite recovery after surgery, strong evidence to support its use in routine postoperative practice is lacking. Methodology A comprehensive literature review of all randomised controlled trials (RCTs) was performed in the Medline and Embase databases between 2000 and 2019. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. The primary outcome assessed was the incidence of POI. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality. Results Sixteen RCTs were included in the systematic review, of which ten (970 patients) were included in the meta-analysis. The incidence of POI was significantly reduced in patients utilising chewing gum compared to those having standard care (RR 0.55, 95% CI 0.39, 0.79, p = 0.0009). These patients also had a significant reduction in time to passage of flatus (WMD − 0.31, 95% CI − 0.36, − 0.26, p < 0.00001) and time to defecation (WMD − 0.47, 95% CI − 0.60, − 0.34, p < 0.00001), without significant differences in the total length of hospital stay or mortality. Conclusion The use of chewing gum after colorectal surgery is a safe and effective intervention in reducing the incidence of POI and merits routine use alongside other ERAS pathways in the postoperative setting.

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