Abstract
Background
Percutaneous endoscopic gastrostomy (PEG) is a widely used and effective means of providing long-term nutrition in patients with inadequate oral intake. The demand for this intervention has risen steadily since the early 1990s. Endoscopists who perform PEG insertion have become increasingly concerned about inappropriate use of this intervention.
Aims
This review addresses the particular areas of difficulty, namely, dementia, stroke, aspiration pneumonia and use of PEG to facilitate discharge from hospital.
Methods
A Pubmed literature search and the author’s personal experience.
Conclusions
Strategies for improving patient selection and a practical approach to difficult decisions are described.
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References
NCEPOD (2004) National confidential enquiry into patient outcome and death: scoping our practice, NCEPOD, London. http://www.ncepod.org.uk
Westaby D, Young A, O’Toole P et al (2010) The provision of a percutaenously placed enteral tube feeding service. Gut 59:1592–1605
Royal College of Physicians (2010) Oral feeding difficulties and dilemmas: a guide to practical care particularly towards the end of life. Royal College of Physicians, London
Finucane TE, Christmas C, Travis K (1999) Tube feeding in patients with advanced dementia: a review of the evidence. JAMA 282(14):1365–1370
Hoffer LJ (2006) Tube feeding in advanced dementia: the metabolic perspective. BMJ 333:1214–1215
Norton B, Homer-Ward M, Donnelly MT, Long RG, Holmes GKT (1996) A randomised prospective comparison of percutaneous endoscopic gastrostomy and nasogastric tube feeding after acute dysphagic stroke. BMJ 312:13–16
Dennis MS, Lewis SC, Warlow C (2005) Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD): a multicentre randomized controlled trial. Lancet 365:764–772
Hallenbeck JL (2003) Hydration, nutrition, and antibiotics in end-of-life care: tube feed or not tube feed? In: Palliative care perspectives, Chap 6. Oxford University Press, New York, pp 117–126
Balan KK, Vinjamuri S, Maltby P et al (1998) Gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG): detection by a simple scintigraphic method. Am J Gastroenterol 93:946–949
Mitchell SL, Teno JM, Roy J et al (2003) Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. JAMA 290:73–80
Powers DA, Brown RO, Cown GS Jr et al (1986) Nutritional support team vs no team management of enteral nutritional support in a Veterans Administration Medical Center teaching hospital. JPEN 10:635–638
Kurien M, Sanders DS (2011) Improving outcomes following percutaneous endoscopic gastrostomy (PEG): a seven-day waiting policy is essential. Clin Med 11(4):411
Skitt LC, Hurley JJ, Turner JK et al (2011) Helping the general physician to improve outcomes after PEG insertion: how we changed our practice. Clin Med 11(2):132–137
Callahan CM, Haag KM, Buchanan NN, Nisi R (1999) Decision-making for percutaneous endoscopic gastrostomy among older adults in a community setting. J Am Geriatr Soc 47(9):1105–1109
Ladas SD, Triantafyllou K, Liappas I et al (2002) Percutanous endoscopic gastrostomy: adequacy and quality of information given to decision makers. Dig Dis Sci 20:289–292
Golan I, Ligumsky M, Brezis M (2007) Percutaneous endoscopic gastrostomy in hospitalized incompetent geriatric patients: poorly informed, constrained and paradoxical decisions. Isr Med Assoc J 9:839–842
Mitchell SL, Berkowitz RE, Lawson FM et al (2000) A cross-national survey of tube-feeding decisions in cognitively-impaired older persons. J Am Geriatr Soc 48:391–397
Sharp HM, Shega JW (2009) Feeding tube placement in patients with advanced dementia: the beliefs and practice patterns of speech-language pathologists. Am J Speech Lang Pathol 18(3):222–230
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O’Mahony, S. Difficulties with percutaneous endoscopic gastrostomy (PEG): a practical guide for the endoscopist. Ir J Med Sci 182, 25–28 (2013). https://doi.org/10.1007/s11845-012-0845-2
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DOI: https://doi.org/10.1007/s11845-012-0845-2