A Double-Edged Sword and Swinging Pendulum: The Evolving Role of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia

Tawfik Khoury, Ayman Abu Rmeileh, Jonah Cohen and Meir Mizrahi*

A Double-Edged Sword and Swinging Pendulum: The Evolving Role of Percutaneous Endoscopic Gastrostomy Tubes in Patients with Advanced Dementia

A commonly encountered challenge in adults with advanced dementia is the
development of difficulty with mastication and swallowing leading to weight loss,
malnutrition and risk of aspiration pneumonia.

One long-term intervention to manage such malnutrition
and risk of aspiration is the provision of enteral feeding through a percutaneous endoscopic
gastrostomy (PEG) tube given the proposed nutritional, medication administration, and quality
of life benefits.

However such benefits are controversial given lack of randomized controlled
data as well as conflicting evidence regarding the prevalence of complications of PEG tubes
compared to the actual benefit received with respect to morbidity and mortality from malnutrition
and dysphagia.

Multiple studies have revealed that PEG tubes in nursing home residents with
advanced dementia do not in fact improve survival, nor prevent or help heal decubitus ulcers
in this group of patients.

Additionally, risks of aspiration are not eliminated by PEG tube placement.
Finally, PEG tube insertion is associated with procedure-related complications
such as bleeding, wound infection, aspiration events, tube leakage and dislodgment,
buriedbumper syndrome, necrotizing fasciitis and peritonitis.

Of note, certain factors have been shown to predict the occurrence of complications
following PEG insertion including low body mass index, malignancy,
low serum albumin and neurologic diseases.

To date, data informing PEG tube placement in adults with advanced dementia elderly is based off of retrospective studies, case series and reviews.

Gastro Open J. 2015; 1(4): e4-e6. doi: 10.17140/GOJ-1-e002

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