Endoscopic- versus x-ray-guidance for placement of nasojejunal tubes in critically ill patients: a systematic review and meta-analysis of randomized controlled trials.

Nasojejunal tubes (NJTs) are increasingly used in critically ill patients. NJT insertion with endoscopic- or x-ray-guidance can be achieved with success rates above 90%. This systematic review and meta-analysis of randomized controlled trials (RCTs) compares the efficiency and safety of these two methods in critically ill patients. We searched Chinese and English databases for RCTs comparing endoscopy- and x-ray-guided NJT placement published up to July 5, 2021. Meta-analyses were performed using RevMan5 software to compute mean differences (MDs) and odds ratios (ORs). Eleven RCTs (n=676) were included. The endoscopic group had a higher procedure success rate (OR=2.14, 95% CI [1.19, 3.85], Z=2.52, P=0.01) and shorter insertion time (MD=-3.70 min, 95% CI [-6.90, -0.50], Z=2.27, P=0.02) than the x-ray group. NJT indwelling time and post-insertion complications were similar between groups. The x-ray group had fewer complications during placement (OR=8.08, 95% CI [3.58, 18.22], Z=5.03, P<0.00001]; on subgroup analysis, only gastrointestinal non-bleeding adverse events differed significantly between groups (OR=2.78, 95% CI [1.43, 5.39], Z=3.03, P=0.002). Visual analog scale discomfort scores were better in the x-ray group (MD=4.10, 95% CI [3.57, 4.63], Z=15.07, P<0.00001). Compared with x-ray-guided NJT placement, endoscopy-guided placement was faster, had a higher success rate, and was associated with fewer gastrointestinal non-bleeding adverse events and less discomfort during insertion. Endoscopic guidance is recommended for NJT placement in critically ill patients to improve placement efficiency. X-ray guidance is a good alternative, depending on the hospital setting, as it is convenient, economical, and potentially safer.