Effectiveness of Different Feeding Techniques for Post-stroke Dysphagia: An Updated Systematic Review and Meta-analysis

Abstract

PurposeWith the improvement of people’s life expectancy, the incidence of stroke is high in the world. Post-stroke Dysphagia seriously affects people’s quality of life, among which malnutrition and pulmonary infection are the most common complications of post-stroke Dysphagia. At this point, it is very important to choose the right enteral and parenteral feeding mode. Current nutrition methods commonly used in patients with dysphagia after stroke include Intermittent oral to esophageal tube feeding (IOE), Nasogastric tube (NG), Nasal Jejunal feeding tubes (NJ), Percutaneous endoscopic gastrostomy (PEG).The purpose of this meta-analysis was to study the prognosis of patients with dysphagia after stroke who chose different nutritional methods.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTS) to examine the effects of different nutritional modalities on outcomes in patients with post-stroke dysphagia. We searched the Cochrane Library, PubMed, Medline, China National Knowledge Infrastructure (CNKI), Wanfang, and the VIP database. The search period is from the library's establishment to December 31, 2021.At least 2 reviewers independently assessed eligibility criteria, extracted data, and assessed the risk of bias. Standardized mean difference (SMD), relative risk (RR), and odds ratio (OR) were calculated using a random-effects model.ResultsFourteen studies were identified across six databases that met the inclusion criteria, The results of meta-analysis showed that Intermittent oral to esophageal tube feeding (IOE) could improve the nutritional levels of patients better than nasogastric tube (NG) (MD 1.95, 95%CI 1.22–2.67, P < 0.00001, I2 = 0%), and reduced the incidence of aspiration pneumonia (RR 0.39, 95%CI 0.23–0.66, P = 0.0004, I2 = 0%), improved swallowing function (OR 3.92, 95%CI 2.15–7.14, P < 0.00001, I2 = 0%). Although Percutaneous endoscopic gastrostomy (PEG) can improve the nutrition of patients in the short term, the long-term prognosis remains to be discussed. In addition, the Nasal Jejunal feeding tubes (NJ) significantly reduced the incidence of post-stroke pneumonia compared with NG (RR 0.51, 95%CI 0.29–0.92, P = 0.03, I2 = 0%).ConclusionsAccording to the results of meta-analysis, IOE can better improve the nutritional level of patients and reduce the incidence of complications. However, due to the lack of popularity and small target clients, patients who do not accept IOE enteral feeding for various reasons and choose nasal feeding can consider using NJ as a long-term enteral feeding method, and guard against adverse events when performing supplementary nutrition.