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

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.