Gastroenterol Res

Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access

Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc

Journal website https://www.gastrores.org

Original Article

Volume 16, Number 2, April 2023, pages 79-91

Outcomes and Complications of Radiological Gastrostomy vs. Percutaneous Endoscopic Gastrostomy for Enteral Feeding: An Updated Systematic Review and Meta-Analysis

Figure 3. Forest plot of (a) 30-day mortality, (b) tube leakage, and (c) tube dislodgement between PRG and PEG. PEG: percutaneous endoscopic gastrostomy; PRG: percutaneous radiological gastrostomy.

**Table 1.** Study Characteristics
Study	Year	Demographics	Study design	Total	PRG	PEG	Indications
ALS: amyotrophic lateral sclerosis; CVA: cerebrovascular accident; HNC: head and neck cancers; NR: not reported; NMDs: neuromuscular disorders; PEG: percutaneous endoscopic gastrostomy; PRG: percutaneous radiological gastrostomy; SD: standard deviation.
Allen et al [16]	2013	Mean age in PRG = 61 (SD ± 10.4); Mean age in PEG = 62 (SD ± 11.3); Male in PRG = 30 (57%); Male in PEG = 35 (61%)	Retrospective	108	51	57	ALS
Alvarez-Alvarez et al [17]	2022	Mean age overall: 66; Male overall: 41%	Retrospective	25	4	21	ALS
Bazarah et al [18]	2002	Mean age in PRG = 51; Mean age in PEG = 65; Male in PRG = 16 (48%); Male in PEG = 14 (73%)	Retrospective	52	33	19	Neurological disorders (60%); HNC (21.2%); other
Blondet et al [19]	2010	Mean age in PRG = 66 (SD ± 12); Mean age in PEG = 66 (SD ± 11.2); Male in PRG = 11 (50%); Male in PEG = 6 (33%)	Retrospective	43	22	21	ALS
Carey et al [20]	2004	NR	Retrospective	182	96	86	NR
Chandran et al [21]	2017	Median age in PRG = 64; Median age in PEG = 65; Male in PRG = 34 (65.4%); Male in PEG = 54 (63.5%)	Retrospective	137	52	85	HNC (37.2%); CVA (27.7%); NMDs (6.6%); trauma (6.6%); esophageal cancer (5.8%); other (16.1%)
Cherian et al [22]	2019	Median age in PRG = 65 (35 - 89); Median age in PEG = 62 (18 - 91); Male in PRG = 65 (68%); Male in PEG = 242 (61%)	Retrospective	403	95	308	HNC (62.9%); non-HNC malignancy (11%); other (26.1%)
Chio et al [23]	2004	Mean age in PRG = 69 (SD ± 9.5); Mean age in PEG = 65 (SD ± 10.3); Male in PRG = 12 (48%); Male in PEG = 13 (52%)	Retrospective	25	25	50	ALS
Clayton et al [24]	2019	Mean age in PRG = 62 (SD ± 16.4); Mean age in PEG = 66 (SD ± 17.3); Male in PRG = 82 (54%); Male in PEG = 90 (61%)	Retrospective	297	150	147	Gastrointestinal disorders (59.9%); neurological disorders (19.5%); other (17.8%)
Cosentini et al [25]	1998	Median age in PRG = 57 (20 - 84); Median age in PEG = 55 (10 - 90); Male in PRG = 28 (63%); Male in PEG = 16 (66%)	Retrospective	68	44	24	HNC (66%); neurological disorders (19%); esophageal perforation (4%); cachexia (4%); esophageal cancer (3%); gastric cancer/decompression (3%)
Desport et al [26]	2005	Mean age in PRG = 66 (SD ± 9.7); Mean age in PEG = 65 (SD ± 10.3); Male in PRG = 5 (25%); Male in PEG = 21 (70%)	Retrospective	50	20	30	ALS
El Chaarani et al [27]	2014	Mean age in PRG = 69; Mean age in PEG = 72; Male in PRG = 111 (60%); Male in PEG = 87 (42%)	Retrospective	394	186	208	NR
Elliot et al [28]	1996	NR	Prospective (non-randomized controlled trial (non-RCT))	78	45	33	CVA (42%); cystic fibrosis (22%); malignancy (8%); chest disease (4%); other (24%)
Galaski et al [29]	2009	Mean age in PRG = 65 (SD ± 19); Mean age in PEG = 55 (SD ± 21); Male in PRG = 31 (71%); Male in PEG = 19 (63%)	Retrospective	74	44	30	Neurological disorders (31.1%); trauma (17.6%); HNC (10.8%); coronary artery disease (10.8%); other
Grant et al [30]	2009	Mean age in PRG = 65 (36 - 95); Mean age in PEG = 61 (28 - 97); Male in PRG = 39 (77%); Male in PEG = 79 (65%)	Prospective (non-RCT)	172	51	121	HNC
Hazratjee et al [31]	2012	NR	Retrospective	267	70	197	NR
Hoffer et al [32]	1999	Mean age in PRG = 58 (18 - 93); Mean age in PEG = 52 (18 - 89); Male in PRG = 36 (55%); Male in PEG = 41 (59%)	Prospective (RCT)	135	66	69	Neurological impairment (80.7%); HNC (11.9%); gastrointestinal decompression (3%); other (4.4%)
Kim et al [33]	2014	Mean age overall = 60 (SD ± 17.5); Male overall = 102 (74%)	Retrospective	138	48	90	Unable to eat (67.4%); recurrent aspiration (18.1%); esophageal stricture (10.1%)
Kohli et al [34]	2021	Mean age in PRG = 70 (SD ± 9.7); Mean age in PEG = 71 (SD ± 10.2); Male in PRG = 9,432 (97.1%); Male in PEG = 22,989 (97.6%)	Retrospective (Nationwide Veterans Affairs Database)	33,281	9,715	23,566	Dysphagia/aphagia (86%); malignancy (65%); other non-malignant disorders including neurological diseases and aspiration pneumonia
Kohli et al [35]	2021	Mean age in PRG = 67 (SD ± 17.5); Mean age in PEG = 54 (SD ± 29); Male in PRG = 86,262 (56%); Male in PEG = 8,855 (54%)	Retrospective (Nationwide Readmissions Database)	170,391	154,007	16,384	Dysphagia/aphagia (48%); malignancy including HNC; non-malignant disorders including neurological diseases, aspiration pneumonia, and sepsis
Kohli et al [36]	2022	Mean age in PRG = 68.6 (SD ± 8.23); Mean age in PEG = 68.3 (SD ± 7.13); Male in PRG = 100%; Male in PEG = 100%	Prospective (non-RCT)	92	45	47	HNC; esophageal cancer; other cancer; critical illness/ALS
La Nauze et al [37]	2012	Median age in PRG = 61 (16 - 92); Median age in PEG = 61 (16 - 94); Male in PRG = 69 (71%); Male in PEG = 53 (66%)	Retrospective	177	97	80	HNC (27%); trauma (25%); stroke (23%); neuromuscular diseases/dementia (10%); other
Laasch et al [38]	2003	Mean age in PRG = 68 (27 - 86); Mean age in PEG = 73 (19 - 96); Sex = NR	Retrospective	100	50	50	Neurological disorders; malignancy; nutritional support; other
Laskaratos et al [39]	2012	Mean age in PRG = 76.2 (48 - 93); Mean age in PEG = 69.4 (21 - 93); Male in PRG = 20 (50%); Male in PEG = 24 (45%)	Retrospective	93	40	53	CVA (31.2%); NMDs (30%); HNC (18.3%); other (22.6%)
Leeds et al [40]	2010	Mean age in PRG = 63; Mean age in PEG = 62; Male in PRG = 119 (70%); Male in PEG = 146 (64%)	Retrospective	403	170	233	HNC (43%); neurological diseases (29%); dysphagic stroke (9%); other
Maasarani et al [41]	2020	Age = NR; Male in PRG = 14,416 (54.4%); Male in PEG = 110,933 (47.8%)	Retrospective	258,641	26,477	232,164	NR
MacLean et al [42]	2007	Mean age in PRG = 57 (SD ± 19); Mean age in PEG = 51 (SD ± 21); Male in PRG = 113 (42%); Male in PEG = 74 (67%)	Retrospective	378	110	268	Gastrointestinal surgery (21%); trauma and burns (12%); head and neck surgery (9%); gastrointestinal obstruction (7%); other
McAllister et al [43]	2013	NR	Retrospective	110	89	21	HNC
McDermott et al [44]	2015	Mean age in PRG = 63.6 (SD ± 9.8); Mean age in PEG = 64.2 (SD ± 11.7); Male in PRG = 62 (51%); Male in PEG = 90 (55%)	Retrospective	284	121	163	ALS
Moller et al [45]	1999	Median age in PRG = 64 (20 - 92); Median age in PEG = 48 (29 - 73); Male in PRG = 49 (52%); Male in PEG = 6 (50%)	Retrospective	106	94	12	Neurological disorders (42%); malignancy (38%); other (20%)
Neeff et al [46]	2003	Mean age in PRG = 66 (SD ± 12); Mean age in PEG = 65 (SD ± 10.5); Male in PRG = 13 (72%); Male in PEG = 43 (77%)	Retrospective	74	18	56	HNC
Pannick et al [47]	2019	Median age overall = 64; Sex = NR	Retrospective	155	132	33	Dysphagia (45.2%); HNC (36.8%); stroke (12.3%)
Park et al [6]	2019	Mean age in PRG = 66 (SD ± 13.3); Mean age in PEG = 67 (SD ± 14.8); Male in PRG = 58 (62%); Male in PEG = 234 (72%)	Retrospective	418	94	324	Neurological diseases (70.8%); HNC (14.6%); esophageal cancer (6.5%); other
Pinar-Gutierrez et al [48]	2021	NR	Retrospective	896	330	896	NR
Abd Rahim et al [49]	2014	NR	Retrospective	244	168	76	Intracranial events; HNC; dysphagia
Righetti et al [50]	2020	Mean age in PRG = 64.1 (SD ± 12.6); Mean age in PEG = 63.0 (SD ± 15.0); Male in PRG = 340 (65.5%); Male in PEG = 134 (49.6%)	Retrospective	789	519	270	Neurological indications (29%); cancer (36%); chronic aspiration (4.4%); malnutrition (22%); gastric outlet obstruction (8.4%); other (5.7%)
Rio et al [51]	2010	Mean age overall = 62 (SD ± 12); Sex = NR	Retrospective	142	121	21	Motor neuron disease
Rustom et al [52]	2006	Mean age in PRG = 64.8; Mean age in PEG = 63.6; Male in PRG = 15 (53.6%); Male in PEG = 24 (60%)	Retrospective	68	28	40	HNC
Silas et al [53]	2005	Mean age in PRG = 63 (SD ± 14); Mean age in PEG = 68 (SD ± 15); Male in PRG = 114 (59.1%); Male in PEG = 100 (56.5%)	Retrospective	370	193	177	Nutrition/dysphagia (93%); decompression (7%); neurological disorders (34%); malignancy (47%)
Strijbos et al [54]	2019	Mean age in PRG = 62 (SD ± 15); Mean age in PEG = 63 (SD ± 11); Male in PRG = 305 (65%); Male in PEG = 173 (60%)	Retrospective	760	469	291	HNC (58%); ALS (7%); CVA (7%); Neurological disorders (7%); other including gastrointestinal and muscular diseases
Tan et al [55]	2019	Mean age overall = 66 (21 - 102); Male overall = 134 (54%)	Retrospective	248	90	158	Altered mental status (37%); cognitive impairment (16%); malignancy (15%); dysphagia (14%); other (18%)
Vashi et al [56]	2015	Mean age in PRG = 56 (SD ± 9.1); Mean age in PEG = 54 (SD ± 10.7); Male in PRG = 30 (57.7%); Male in PEG = 45 (55.6%)	Retrospective	133	52	81	Malignancy causing dysphagia, malnutrition, or need for decompression
Wollman et al [57]	1997	Mean age in PRG = 54 (15 - 89); Mean age in PEG = 55 (12 - 94); Male in PRG = 38 (56%); Male in PEG = 71 (62%)	Retrospective	182	68	114	Neurological impairment (59.9%); HNC (20.9%); decompression (6.6%); other (12.6%)

Table 1. Study Characteristics

Study

Year

Demographics

Study design

Total

PRG

PEG

Indications

ALS: amyotrophic lateral sclerosis; CVA: cerebrovascular accident; HNC: head and neck cancers; NR: not reported; NMDs: neuromuscular disorders; PEG: percutaneous endoscopic gastrostomy; PRG: percutaneous radiological gastrostomy; SD: standard deviation.

Allen et al [16]

2013

Mean age in PRG = 61 (SD ± 10.4); Mean age in PEG = 62 (SD ± 11.3); Male in PRG = 30 (57%); Male in PEG = 35 (61%)

Retrospective

108

ALS

Alvarez-Alvarez et al [17]

2022

Mean age overall: 66; Male overall: 41%

Retrospective

ALS

Bazarah et al [18]

2002

Mean age in PRG = 51; Mean age in PEG = 65; Male in PRG = 16 (48%); Male in PEG = 14 (73%)

Retrospective

Neurological disorders (60%); HNC (21.2%); other

Blondet et al [19]

2010

Mean age in PRG = 66 (SD ± 12); Mean age in PEG = 66 (SD ± 11.2); Male in PRG = 11 (50%); Male in PEG = 6 (33%)

Retrospective

ALS

Carey et al [20]

2004

Retrospective

182

Chandran et al [21]

2017

Median age in PRG = 64; Median age in PEG = 65; Male in PRG = 34 (65.4%); Male in PEG = 54 (63.5%)

Retrospective

137

HNC (37.2%); CVA (27.7%); NMDs (6.6%); trauma (6.6%); esophageal cancer (5.8%); other (16.1%)

Cherian et al [22]

2019

Median age in PRG = 65 (35 - 89); Median age in PEG = 62 (18 - 91); Male in PRG = 65 (68%); Male in PEG = 242 (61%)

Retrospective

403

308

HNC (62.9%); non-HNC malignancy (11%); other (26.1%)

Chio et al [23]

2004

Mean age in PRG = 69 (SD ± 9.5); Mean age in PEG = 65 (SD ± 10.3); Male in PRG = 12 (48%); Male in PEG = 13 (52%)

Retrospective

ALS

Clayton et al [24]

2019

Mean age in PRG = 62 (SD ± 16.4); Mean age in PEG = 66 (SD ± 17.3); Male in PRG = 82 (54%); Male in PEG = 90 (61%)

Retrospective

297

150

147

Gastrointestinal disorders (59.9%); neurological disorders (19.5%); other (17.8%)

Cosentini et al [25]

1998

Median age in PRG = 57 (20 - 84); Median age in PEG = 55 (10 - 90); Male in PRG = 28 (63%); Male in PEG = 16 (66%)

Retrospective

HNC (66%); neurological disorders (19%); esophageal perforation (4%); cachexia (4%); esophageal cancer (3%); gastric cancer/decompression (3%)

Desport et al [26]

2005

Mean age in PRG = 66 (SD ± 9.7); Mean age in PEG = 65 (SD ± 10.3); Male in PRG = 5 (25%); Male in PEG = 21 (70%)

Retrospective

ALS

El Chaarani et al [27]

2014

Mean age in PRG = 69; Mean age in PEG = 72; Male in PRG = 111 (60%); Male in PEG = 87 (42%)

Retrospective

394

186

208

Elliot et al [28]

1996

Prospective (non-randomized controlled trial (non-RCT))

CVA (42%); cystic fibrosis (22%); malignancy (8%); chest disease (4%); other (24%)

Galaski et al [29]

2009

Mean age in PRG = 65 (SD ± 19); Mean age in PEG = 55 (SD ± 21); Male in PRG = 31 (71%); Male in PEG = 19 (63%)

Retrospective

Neurological disorders (31.1%); trauma (17.6%); HNC (10.8%); coronary artery disease (10.8%); other

Grant et al [30]

2009

Mean age in PRG = 65 (36 - 95); Mean age in PEG = 61 (28 - 97); Male in PRG = 39 (77%); Male in PEG = 79 (65%)

Prospective (non-RCT)

172

121

HNC

Hazratjee et al [31]

2012

Retrospective

267

197

Hoffer et al [32]

1999

Mean age in PRG = 58 (18 - 93); Mean age in PEG = 52 (18 - 89); Male in PRG = 36 (55%); Male in PEG = 41 (59%)

Prospective (RCT)

135

Neurological impairment (80.7%); HNC (11.9%); gastrointestinal decompression (3%); other (4.4%)

Kim et al [33]

2014

Mean age overall = 60 (SD ± 17.5); Male overall = 102 (74%)

Retrospective

138

Unable to eat (67.4%); recurrent aspiration (18.1%); esophageal stricture (10.1%)

Kohli et al [34]

2021

Mean age in PRG = 70 (SD ± 9.7); Mean age in PEG = 71 (SD ± 10.2); Male in PRG = 9,432 (97.1%); Male in PEG = 22,989 (97.6%)

Retrospective (Nationwide Veterans Affairs Database)

33,281

9,715

23,566

Dysphagia/aphagia (86%); malignancy (65%); other non-malignant disorders including neurological diseases and aspiration pneumonia

Kohli et al [35]

2021

Mean age in PRG = 67 (SD ± 17.5); Mean age in PEG = 54 (SD ± 29); Male in PRG = 86,262 (56%); Male in PEG = 8,855 (54%)

Retrospective (Nationwide Readmissions Database)

170,391

154,007

16,384

Dysphagia/aphagia (48%); malignancy including HNC; non-malignant disorders including neurological diseases, aspiration pneumonia, and sepsis

Kohli et al [36]

2022

Mean age in PRG = 68.6 (SD ± 8.23); Mean age in PEG = 68.3 (SD ± 7.13); Male in PRG = 100%; Male in PEG = 100%

Prospective (non-RCT)

HNC; esophageal cancer; other cancer; critical illness/ALS

La Nauze et al [37]

2012

Median age in PRG = 61 (16 - 92); Median age in PEG = 61 (16 - 94); Male in PRG = 69 (71%); Male in PEG = 53 (66%)

Retrospective

177

HNC (27%); trauma (25%); stroke (23%); neuromuscular diseases/dementia (10%); other

Laasch et al [38]

2003

Mean age in PRG = 68 (27 - 86); Mean age in PEG = 73 (19 - 96); Sex = NR

Retrospective

100

Neurological disorders; malignancy; nutritional support; other

Laskaratos et al [39]

2012

Mean age in PRG = 76.2 (48 - 93); Mean age in PEG = 69.4 (21 - 93); Male in PRG = 20 (50%); Male in PEG = 24 (45%)

Retrospective

CVA (31.2%); NMDs (30%); HNC (18.3%); other (22.6%)

Leeds et al [40]

2010

Mean age in PRG = 63; Mean age in PEG = 62; Male in PRG = 119 (70%); Male in PEG = 146 (64%)

Retrospective

403

170

233

HNC (43%); neurological diseases (29%); dysphagic stroke (9%); other

Maasarani et al [41]

2020

Age = NR; Male in PRG = 14,416 (54.4%); Male in PEG = 110,933 (47.8%)

Retrospective

258,641

26,477

232,164

MacLean et al [42]

2007

Mean age in PRG = 57 (SD ± 19); Mean age in PEG = 51 (SD ± 21); Male in PRG = 113 (42%); Male in PEG = 74 (67%)

Retrospective

378

110

268

Gastrointestinal surgery (21%); trauma and burns (12%); head and neck surgery (9%); gastrointestinal obstruction (7%); other

McAllister et al [43]

2013

Retrospective

110

HNC

McDermott et al [44]

2015

Mean age in PRG = 63.6 (SD ± 9.8); Mean age in PEG = 64.2 (SD ± 11.7); Male in PRG = 62 (51%); Male in PEG = 90 (55%)

Retrospective

284

121

163

ALS

Moller et al [45]

1999

Median age in PRG = 64 (20 - 92); Median age in PEG = 48 (29 - 73); Male in PRG = 49 (52%); Male in PEG = 6 (50%)

Retrospective

106

Neurological disorders (42%); malignancy (38%); other (20%)

Neeff et al [46]

2003

Mean age in PRG = 66 (SD ± 12); Mean age in PEG = 65 (SD ± 10.5); Male in PRG = 13 (72%); Male in PEG = 43 (77%)

Retrospective

HNC

Pannick et al [47]

2019

Median age overall = 64; Sex = NR

Retrospective

155

132

Dysphagia (45.2%); HNC (36.8%); stroke (12.3%)

Park et al [6]

2019

Mean age in PRG = 66 (SD ± 13.3); Mean age in PEG = 67 (SD ± 14.8); Male in PRG = 58 (62%); Male in PEG = 234 (72%)

Retrospective

418

324

Neurological diseases (70.8%); HNC (14.6%); esophageal cancer (6.5%); other

Pinar-Gutierrez et al [48]

2021

Retrospective

896

330

896

Abd Rahim et al [49]

2014

Retrospective

244

168

Intracranial events; HNC; dysphagia

Righetti et al [50]

2020

Mean age in PRG = 64.1 (SD ± 12.6); Mean age in PEG = 63.0 (SD ± 15.0); Male in PRG = 340 (65.5%); Male in PEG = 134 (49.6%)

Retrospective

789

519

270

Neurological indications (29%); cancer (36%); chronic aspiration (4.4%); malnutrition (22%); gastric outlet obstruction (8.4%); other (5.7%)

Rio et al [51]

2010

Mean age overall = 62 (SD ± 12); Sex = NR

Retrospective

142

121

Motor neuron disease

Rustom et al [52]

2006

Mean age in PRG = 64.8; Mean age in PEG = 63.6; Male in PRG = 15 (53.6%); Male in PEG = 24 (60%)

Retrospective

HNC

Silas et al [53]

2005

Mean age in PRG = 63 (SD ± 14); Mean age in PEG = 68 (SD ± 15); Male in PRG = 114 (59.1%); Male in PEG = 100 (56.5%)

Retrospective

370

193

177

Nutrition/dysphagia (93%); decompression (7%); neurological disorders (34%); malignancy (47%)

Strijbos et al [54]

2019

Mean age in PRG = 62 (SD ± 15); Mean age in PEG = 63 (SD ± 11); Male in PRG = 305 (65%); Male in PEG = 173 (60%)

Retrospective

760

469

291

HNC (58%); ALS (7%); CVA (7%); Neurological disorders (7%); other including gastrointestinal and muscular diseases

Tan et al [55]

2019

Mean age overall = 66 (21 - 102); Male overall = 134 (54%)

Retrospective

248

158

Altered mental status (37%); cognitive impairment (16%); malignancy (15%); dysphagia (14%); other (18%)

Vashi et al [56]

2015

Mean age in PRG = 56 (SD ± 9.1); Mean age in PEG = 54 (SD ± 10.7); Male in PRG = 30 (57.7%); Male in PEG = 45 (55.6%)

Retrospective

133

Malignancy causing dysphagia, malnutrition, or need for decompression

Wollman et al [57]

1997

Mean age in PRG = 54 (15 - 89); Mean age in PEG = 55 (12 - 94); Male in PRG = 38 (56%); Male in PEG = 71 (62%)

Retrospective

182

114

Neurological impairment (59.9%); HNC (20.9%); decompression (6.6%); other (12.6%)

**Table 2.** Quality Assessment of Non-Randomized Studies via Methodological Index for Non-Randomized Studies (MINORS)
Studies	Clearly stated aim	Consecutive patient inclusion	Prospective data collection	Appropriate end-points	Appropriate follow-up period	Attrition bias (< 5%)	Adequate control group	Contemporary groups	Baseline equivalence of groups	Statistical analysis	Total score
Allen et al [16]	2	2	2	2	2	2	2	2	2	2	20
Alvarez-Alvarez et al [17]	2	2	2	2	2	2	2	2	1	1	18
Bazarah et al [18]	2	2	2	2	2	2	2	2	2	2	20
Blondet et al [19]	2	2	2	2	2	2	2	2	2	2	20
Carey et al [20]	2	2	2	2	2	2	2	2	1	1	18
Chandran et al [21]	2	2	2	2	2	2	2	2	1	2	19
Cherian et al [22]	2	2	2	2	2	2	2	2	1	2	19
Chio et al [23]	2	2	2	2	2	2	2	2	2	2	20
Clayton et al [24]	2	2	2	2	2	2	2	2	1	2	19
Cosentini et al [25]	2	2	2	2	2	2	2	2	0	2	18
Desport et al [26]	2	2	2	2	2	2	2	2	2	2	20
El Chaarani et al [27]	2	2	2	2	0	2	2	2	1	2	17
Elliot et al [28]	2	2	2	2	2	2	2	2	0	2	18
Galaski et al [29]	2	2	2	2	2	2	2	2	1	2	19
Grant et al [30]	2	2	2	2	2	2	2	2	1	2	19
Hazratjee et al [31]	2	2	2	2	2	2	2	2	1	2	19
Kim et al [32]	2	2	2	2	2	2	2	2	0	1	17
Kohli et al [33]	2	2	2	2	0	2	2	2	0	2	18
Kohli et al (divyanshu) [34]	2	2	2	2	2	2	2	2	0	2	18
Kohli et al [35]	2	2	2	2	2	2	2	2	2	2	20
La Nauze et al [36]	2	2	2	2	2	2	2	2	2	2	20
Laasch et al [37]	2	2	2	2	1	2	2	2	1	2	18
Laskaratos et al [38]	2	2	2	2	2	2	2	2	1	2	19
Leeds et al [39]	2	2	2	2	2	2	2	2	1	2	19
Maasarani et al [40]	2	2	2	2	2	2	2	2	2	2	20
MacLean et al [41]	2	2	2	2	1	2	2	2	0	2	17
McAllister et al [42]	2	2	2	2	2	2	2	2	0	2	18
McDermott et al [43]	2	2	2	2	2	2	2	2	1	2	18
Moller et al [44]	2	2	2	2	2	2	2	2	1	1	18
Neeff et al [45]	2	2	2	2	2	2	2	2	0	1	17
Pannick et al [46]	2	2	2	2	2	2	2	2	0	2	18
Park et al [6]	2	2	2	2	2	2	2	2	2	2	20
Pinar-Gutierrez et al [48]	2	2	2	2	1	2	2	2	0	2	17
Abd Rahim et al [49]	2	2	2	2	2	2	2	2	0	0	12
Righetti et al [50]	2	2	2	2	0	2	2	2	1	2	17
Rio et al [51]	2	2	2	2	2	2	2	2	2	2	20
Rustom et al [52]	2	2	2	2	2	2	2	2	0	0	16
Silas et al [53]	2	2	2	2	2	2	2	2	1	2	19
Strijbos et al [54]	2	2	2	2	2	2	2	2	1	2	19
Tan et al [55]	2	2	2	2	2	2	2	2	0	2	18
Vashi et al [56]	2	2	2	2	2	2	2	2	1	2	19
Wollman et al [57]	2	2	2	2	2	2	2	2	1	2	19

Table 2. Quality Assessment of Non-Randomized Studies via Methodological Index for Non-Randomized Studies (MINORS)

Studies

Clearly stated aim

Consecutive patient inclusion

Prospective data collection

Appropriate end-points

Unbiased study end-point assessment

Appropriate follow-up period

Attrition bias (< 5%)

Sample size

Adequate control group

Contemporary groups

Baseline equivalence of groups

Statistical analysis

Total score

Allen et al [16]

Alvarez-Alvarez et al [17]

Bazarah et al [18]

Blondet et al [19]

Carey et al [20]

Chandran et al [21]

Cherian et al [22]

Chio et al [23]

Clayton et al [24]

Cosentini et al [25]

Desport et al [26]

El Chaarani et al [27]

Elliot et al [28]

Galaski et al [29]

Grant et al [30]

Hazratjee et al [31]

Kim et al [32]

Kohli et al [33]

Kohli et al (divyanshu) [34]

Kohli et al [35]

La Nauze et al [36]

Laasch et al [37]

Laskaratos et al [38]

Leeds et al [39]

Maasarani et al [40]

MacLean et al [41]

McAllister et al [42]

McDermott et al [43]

Moller et al [44]

Neeff et al [45]

Pannick et al [46]

Park et al [6]

Pinar-Gutierrez et al [48]

Abd Rahim et al [49]

Righetti et al [50]

Rio et al [51]

Rustom et al [52]

Silas et al [53]

Strijbos et al [54]

Tan et al [55]

Vashi et al [56]

Wollman et al [57]

**Table 3.** Risk of Bias Assessment of the Included RCTs
Study	Random sequence generation (selection bias)	Allocation concealment (selection bias)	Blinding of participants and personal (performance bias)	Blinding of outcome assessment (detection bias)	Incomplete outcome data (attrition bias)	Selective reporting (reporting bias)	Other bias
RCTs: randomized controlled trials.
Hoffer et al [32]	Low	Low	Low	Low	Low	Low	Low

Table 3. Risk of Bias Assessment of the Included RCTs

Study

Random sequence generation (selection bias)

Allocation concealment (selection bias)

Blinding of participants and personal (performance bias)

Blinding of outcome assessment (detection bias)

Incomplete outcome data (attrition bias)

Selective reporting (reporting bias)

Other bias

RCTs: randomized controlled trials.

Hoffer et al [32]

Low