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

J Intensive Care. 2020 Dec 10;8(1):92. doi: 10.1186/s40560-020-00506-8.


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 ).

Keywords: Electromagnetic; Endoscopy; Enteral nutrition; Post-pyloric feeding tube.