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Received Nov 5, 2017; Revised Jan 15, 2018; Accepted Feb 10, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Background
Successful and early administration of enteral nutrition is important for critically ill patients [1–3]. It can boost immune function, decrease infectious complications, and improve wound healing. However, 50%–60% of critically ill patients suffer from gastroparesis [4]. Due to delayed gastric emptying, the success rate is low in feeding tube insertion and inadequate nutrition, which could even cause gastroesophageal reflux [5]. Once the gastroesophageal reflux occurs, it may cause pulmonary aspiration, pneumonia, and sepsis, which further impacts on mortality.
Postpyloric feeding tube can reduce the risk of complications, because it delivers nutrient directly to the duodenum, which is just like a protective barrier against reflux, instead of the stomach. Usually, there are three methods to place postpyloric tube: bedside blind insertion, insertion under X-ray, and insertion with endoscopy. Because the bedside insertion can be performed conveniently and can also reduce the pain of insertion, it is especially suitable for critically ill patients. Unfortunately, a study reported that only 53.5% of 932 blind postpyloric tube placement attempts succeeded, which means that blind insertion had its disadvantage [6].
Erythromycin is not only an antibiotic, but also a gastric prokinetic drug. It is a motilin receptor agonist which can promote motilin secretion and thereby enhance the gastric emptying [7]. Previous studies showed that erythromycin could increase the success rate of postpyloric tube insertion [8–11], but its clinical efficiency still remains controversial. The purpose of this meta-analysis was to evaluate the success rate and complications of erythromycin in postpyloric tube insertion.
2. Methods
2.1. Search Strategy
Relevant articles were retrieved from Medline, Embase, Web of Science, China national knowledge internet, ChinaInfo, and the Cochrane controlled trials registered from update to January 2018. The following words “erythromycin, gastrointestinal motility, enteral nutrition, nasogastric feeding, post-pyloric feeding tubes” were used as retrieval words. The retrieval language was not limited to English. The references from articles were also used.
2.2. Study Selection
Included studies must meet the following criteria:
(1)
Study design: randomized controlled trial (RCT)
(2)
Population: critically ill...