Early vs Delayed Feeding after Endoscopic Esophageal Variceal Ligation: A Systematic Review and Meta-Analysis

Author(s): Mona Hassan, Joyce Badal, Syeda Faiza Arif, Mohamad Nawras, Ahmad Nawaz, Muhammad Aziz, Anita Kottapalli, Wade Lee Smith, Umer Farooq, Manesh Kumar Gangwani, Abdallah Kobeissy, Zohaib Ahmed

Endoscopic esophageal variceal ligation (EVL) is the recommended endoscopic modality to achieve hemostasis of actively bleeding esophageal varices and is also utilized for primary and secondary prophylaxis. Physicians may delay feeding up to 48-72 hours after EVL due to concerns of precipitating rebleeding. We conducted a systematic review of the literature using Embase, Medline, the Cochrane Central Register of Controlled Trials, and the Web of Science Core Collection to identify all studies that compared outcomes of early vs delayed feeding in patients after undergoing EVL. All analyses were conducted using RevMan metaanalysis software. Four RCTs, including 271 patients (average age 49.8 years and 82.9% male) were included in the final meta-analysis. The average Child-Pugh scores in the early and delayed feeding groups were 8.5 and 8.4 respectively, and the average MELD scores were 13.7 and 13.6 respectively. The early refeeding group had a significantly shorter length of hospital stay, by an estimated 1.59 days, compared to the delayed feeding group (95% CI: -2.06, -1.11, p<0.00001, I2=0%). There was no significant difference between the groups regarding post-EVL rebleeding rates (RR: 0.65, 95% CI: 0.22-1.91, p=0.44, I2=0%), development of ascites (RR: 0.58, 95% CI: 0.25-1.34, p=0.2, I2=0%), infection (RR: 0.59, 95% CI: 0.15-2.28, p=0.44, I2=47%), or overall mortality (RR: 0.55, 95% CI: 0.15-2.03, p=0.37, I2=0%). In conclusion, early feeding is safe and associated with a decreased length of hospital stay in patients after undergoing EVL for esophageal varices.