Percutaneous endoscopic gastrostomy versus fluoroscopic gastrostomy in amyotrophic lateral sclerosis (ALS) sufferers with nutritional impairment: A meta-analysis of current studies

Biying Yang and Xiaolei Shi _

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Oncotarget. 2017; 8:102244-102253. https://doi.org/10.18632/oncotarget.22288

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Biying Yang1 and Xiaolei Shi2,3

1Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P.R. China

2Department of Neurology, The First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, P.R. China

3Kinsmen Laboratory of Neurological Research, University of British Columbia, Vancouver, BC, Canada

Correspondence to:

Xiaolei Shi, email: [email protected]

Keywords: amyotrophic lateral sclerosis (ALS); gastrostomy; meta-analysis

Received: June 10, 2017     Accepted: October 13, 2017     Published: November 06, 2017


Gastrostomy is recommended for Amyotrophic Lateral Sclerosis (ALS) patients with malnutrition. There are two main methods of gastrostomy insertion: Percutaneous Endoscopic Gastrostomy (PEG) and Fluoroscopic Gastrostomy (FG). The latter included Radiologically Inserted Gastrostomy (RIG) and Per-oral Image-Guided Gastrostomy (PRG). A meta-analysis was conducted to compare these approaches in terms of survival outcomes, pain occurrence and success rate, through the literature search in PubMed, Web of Science and Cochrane Library. A total of 7 studies with 701 cases (322 in PEG, 264 in RIG and 115 in PRG) were enrolled in the final analysis. The lack of differences between the comparisons (PEG vs. PRG, PEG vs. RIG and PEG vs. PRG+RIG) on 30-day mortality and survival length was confirmed. For the pooling analysis of peri- and post-procedural complications, patients with PEG had a lower incidence of pain than cases with PRG and RIG together (P < 0.001). The same trends could be found when compared with PRG and RIG, separately (P < 0.05 and P < 0.001, respectively). And PEG showed a lower rate of successful attempts than PEG and RIG (P < 0.05). For other complications, we didn’t find any differences. This meta-analysis demonstrates that PEG, PRG and RIG had their intrinsic advantages. The current evidences could not determine the preference of them. Further investigations should be done to reveal the most appropriate method for ALS patients.

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