iGIE最新文献

{"title":"Comparative analysis of early versus late feeding after an EGD-based intervention: meta-analysis","authors":"Priyadarshini Loganathan MD ,&nbsp;Babu P. Mohan MD ,&nbsp;Mahesh Gajendran MD ,&nbsp;Shreyas Saligram MD ,&nbsp;David Alderman MS ,&nbsp;Vishali Moond MD ,&nbsp;Saurabh Chandan MD ,&nbsp;Douglas G. Adler MD","doi":"10.1016/j.igie.2024.02.003","DOIUrl":"10.1016/j.igie.2024.02.003","url":null,"abstract":"<div><h3>Background and Aims</h3><p>The right time to restart feeding after EGD-based interventions is not well established. However, impaired nutrition from prolonged fasting may lead to unfavorable clinical outcomes. Herein, we performed a systematic review and meta-analysis to study the impact of early feeding (within 24 hours) versus late feeding (&gt;24 hours) in patients undergoing acute therapeutic EGD-based interventions.</p></div><div><h3>Methods</h3><p>Multiple databases, including MEDLINE, Scopus, and Embase, were searched (in May 2022) using specific terms for studies evaluating the outcomes of early versus late feeding after EGD-based interventions. Outcomes of interest were early recurrent bleed (&lt;7 days), late recurrent bleed (&gt;7 days), mortality rates, length of hospital stay, and rate of blood transfusion. Standard meta-analysis methods were used using the random-effects model. <em>I</em>²% heterogeneity was used to assess the heterogeneity. The Grading of Recommendations Assessment, Development and Evaluation Working Group approach was used to assess the certainty of evidence.</p></div><div><h3>Results</h3><p>Eight studies (813 patients) were included in the final analysis. The “early feeding” cohort included 411 patients (31% women) with a mean age of 58 years, and the “late feeding” cohort included 402 patients (26.4% women) with a mean age of 57 years. Four studies (283 patients) evaluated patients with band ligation/sclerotherapy in acute variceal bleeding (224 patients), 2 studies (309 patients) with endoscopic treatment of peptic ulcer bleeding, and 2 studies in endoscopic mucosal dissection for gastric mucosal epithelial neoplasia. The pooled risk ratio (RR) of early recurrent bleeding in early feeding versus late feeding was 1.6 (95% confidence interval [CI], .7-3.7; <em>I</em>² = 0%, <em>P</em> = .2). Similarly, the RR of late recurrent bleeding was .9 (95% CI, .4-2.3; <em>I</em>² = 0%, <em>P</em> = .9). The pooled RR of total recurrent bleeding was 1.2 (95% CI, .7-2.2; <em>I</em>² = 0%, <em>P</em> =.3). The pooled RR of mortality between the early feeding and late feeding groups was .6 (95% CI, .3-1.2; <em>I</em>² = 0%, <em>P</em> = .16). The pooled rate of the standard difference of the mean length of hospital stay was –1.184 (95% CI, –1.5 to –.81; <em>I</em>² = 92%, <em>P</em> = .00) between the early and late feeding groups. The pooled rate of the mean difference in blood transfusion between early and late feeding groups was .1 (95% CI, –.4 to .41; <em>I</em>² = 77.6%, <em>P</em> = .96).</p></div><div><h3>Conclusions</h3><p>Our meta-analysis demonstrates early enteral feeding within 24 hours does not appear to have a higher risk of recurrent bleeding and mortality than delayed enteral feeding in patients undergoing EGD-based therapeutic interventions. However, early feeding is associated with a shorter length of hospital stay compared","PeriodicalId":100652,"journal":{"name":"iGIE","volume":"3 2","pages":"Pages 193-201.e12"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949708624000153/pdfft?md5=c938f1df9fde4a9b8e993541dc498a2a&pid=1-s2.0-S2949708624000153-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139821118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}