A number of conditions compromise the transport of food along the digestive tract. Patients with swallowing disturbances can develop low nutritional status, which affects their recovery from illness, surgery, and injury. Conditions associated with swallowing disorders include neurological diseases, dementia, cancers of the head and neck, amyotrophic lateral sclerosis, physical obstruction, and dysphagia from stroke. Nasogastric tube feeding is a time proven technique to provide nutritional support; the tube can be inserted by a nurse. Percutaneous endoscopy gastrostomy (PEG) involves a feeding tube inserted directly into the stomach through the abdomen and is particularly useful when enteral nutrition is needed for a length of time. Prolonged use of a nasal tube can lead to complications such as damage to the nose and larynx, chronic sinusitis, gastro-oesophageal reflux, and aspirative pneumonia.
We obtained updated evidence for this review from nine controlled studies comparing a nasogastric tube with PEG in a total of 686 patients. Seven studies measured feeding interruption, blocking or leakage of the feeding tube or lack of adherence to treatment in 314 patients randomised to either a nasal gastric tube or PEG. The studies showed a higher probability of treatment failure and development of pneumonia with a nasal gastric tube. The number of deaths was no different with the two methods; nor was the overall occurrence of complications. Possible limitations of this review include the small number of participants in the majority of studies, explained by the high cost of PEG and requirements for endoscopy in its use, the operational challenges to accomplish a clinical trial in this area and the different length of follow-up of the patients in the studies (from no more than four weeks to six months).