Eight studies (818 participants) were included in the review: four studies were retrospective and four were prospective; one prospective study was an RCT. Studies scored from 5 to 9 points on the quality assessment scale.
Nutrition status was measured in seven of the eight included studies. Using various measures, two studies found significant signs of better nutrition status for gastronomy than nasogastric feeding, four studies found no significant difference and one reported mixed results.
Infection rate was not significantly different between feeding methods in the four studies that reported this outcome (relative risk 1.13, 95% CI 0.08 to 16.43; Ι²=92%). Tube dislodgement was found to be more likely with nasogastric tube feeding in the four studies that reported this outcome (relative risk 0.17, 95% CI 0.07 to 0.40; Ι²=36%). Dysphagia at six months after radiotherapy was significantly more common with percutaneous gastrostomy in the two studies that reported this outcome (relative risk 3.62, 95% CI 1.48 to 8.87; Ι²=0%). Other complications were reported in a minority of studies.
Survival was reported in three studies at different time points. When pooled, these suggested no significant difference between feeding methods (relative risk 0.45, 95% CI 0.10 to 2.06; Ι²=97%).
Duration of feeding was longer with nasogastric tube in six studies (data not shown).
Three studies reported no obvious differences between groups in terms of radiotherapy delay and three studies suggested higher incidence of pain with gastrostomy tubes in the first week of insertion. More patients reported altered body image with a nasogastric tube.