Percutaneous Endoscopic Gastrostomy: Use and Abuse in Clinical Practice

Angelo Zelante*, Sergio Sartori and Lucio Trevisani

Percutaneous Endoscopic Gastrostomy: Use and Abuse in Clinical Practice

Nowadays, Percutaneous Endoscopic Gastrostomy (PEG) is considered the method
of choice for long-term enteral feeding, and is spreading all over the world because of its effectiveness and easy carrying out. This review encompasses indications and contraindications
of PEG tube placement, and deals with the problem of the growing disconnect between scientific evidence and clinical practice. Despite the evidence shows an advantage in the outcome
from PEG placement only in selected subgroups of patients, this technique is also used for
questionable indications in clinical practice, such as advanced dementia, permanent vegetative
state, and even in end-life patients. Such an overuse is indirectly confirmed by several studies
reporting a high 30-day mortality rate after PEG placement in elderly patients. The decision
of placing PEG in end-stage patients involves very complex ethical issues, and the authors of
this review are not so pretentious as to think themselves capable of dealing with and solving
such a dramatic issue. However, patients’ interests should be better protected by a case-by-case
decision making, based not only on technical competence, but also on sympathetic awareness,
avoiding to perform procedures that can be disadvantageous for the patients.

Gastro Open J. 2015; 1(3): 61-65. doi: 10.17140/GOJ-1-110

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