Percutaneous endoscopic gastrostomy versus nasogastric tube feeding in post-stroke dysphagia: a meta-analysis study

BACKGROUND: Post-stroke dysphagia affects half of survivors and leads to serious complications. Nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) are primary feeding methods, yet their comparative effectiveness remains controversial. OBJECTIVE: This meta-analysis compared PEG versus NGT feeding in post-stroke dysphagia regarding mortality, pneumonia, nutritional outcomes, and length of stay (LOS). Methods Following PRISMA guidelines, we searched MEDLINE, EMBASE, Cochrane Library, and PubMed. Ten studies (N=1,416) were included. Pooled risk ratios (RR) and mean differences (MD) were calculated using random-effects models in R-4.2.1. Quality was assessed via the Downs and Black checklist. RESULTS: Compared to NGT, PEG showed a 30% reduction in mortality risk (RR 0.70; 95% CI 0.50-0.98; p = 0.039); however, this was not significant in sensitivity analysis restricted to RCTs. PEG also showed a 47% reduction in pneumonia risk (RR 0.53; 95% CI 0.42-0.67; p < 0.001). Nutrition favored PEG, with significantly higher serum albumin (MD +4.56 g/L; 95% CI 1.25-7.87; p = 0.007). No significant differences occurred in mid-arm circumference (p = 0.16) or LOS (p = 0.34). Heterogeneity was moderate for mortality (I² = 47.5%) and low for pneumonia (I² = 0%). CONCLUSION: PEG significantly reduces pneumonia risk and may improve nutritional outcomes compared to NGT. Mortality benefits were not confirmed in RCT-only analyses, suggesting possible confounding. Feeding decisions should balance benefits, procedural risks, and patient-specific factors, emphasizing shared decision-making. Further high-quality RCTs are warranted.