Comparative analysis of early versus late feeding after an EGD-based intervention: meta-analysis.

Abstract

<h4>Background and aims</h4>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 (>24 hours) in patients undergoing acute therapeutic EGD-based interventions.<h4>Methods</h4>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 (<7 days), late recurrent bleed (>7 days), mortality rates, length of hospital stay, and rate of blood transfusion. Standard meta-analysis methods were used using the random-effects model. <i>I</i> 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.<h4>Results</h4>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; <i>I</i> ² = 0%, <i>P</i> = .2). Similarly, the RR of late recurrent bleeding was .9 (95% CI, .4-2.3; <i>I</i> ² = 0%, <i>P</i> = .9). The pooled RR of total recurrent bleeding was 1.2 (95% CI, .7-2.2; <i>I</i> ² = 0%, <i>P</i> =.3). The pooled RR of mortality between the early feeding and late feeding groups was .6 (95% CI, .3-1.2; <i>I</i> ² = 0%, <i>P</i> = .16). The pooled rate of the standard difference of the mean length of hospital stay was -1.184 (95% CI, -1.5 to -.81; <i>I</i> ² = 92%, <i>P</i> = .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; <i>I</i> ² = 77.6%, <i>P</i> = .96).<h4>Conclusions</h4>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 with late feeding.