GASTROENTEROLOGY ARTICLE OF THE WEEK
May 8, 2003
Angus F, Burakoff R. The percutaneous endoscopic gastrostomy tube: Medical and Ethical issues in placement. Am J Gastroenterol 2003;98:272-277.
1. PEG tube in elderly patients over age 60:
a. prevent aspiration
b. are associated with improved wound healing
c. improve nutritional status of the patient
d. provides comfort
2. In cancer patients
a. malnutrition is usually protein-calorie manifested as a loss of body cell mass
b. PEG tube is indicated when there is a reasonable expectation of response to
chemo or radiation therapy.
c. When the natural history of the untreated tumor is expected to be protracted (>6 months), PEG tube placement is reasonable.
d. PEG tube placement is not indicated in patients with untreatable tumors and life expectancy of less than 1-2 months
e. PEG tube placement may prevent deterioration of quality of life in patients with ENT tumors.
True or False
3. Providers are legally and ethically obligated to provide artificial nutrition and hydration to all patients.
4. For patients with anorexia-cachexia syndromes (ie. Terminal cancer, end stage AIDS) PEG should not be offered, as there is no benefit to the patient.
5. The majority of patients with Alzheimer’s disease who receive a PEG tube fail to achieve any meaningful improvement in nutritional status, functional status or subjective health status.
6. After a stroke, if the dysphagia has not improved in 5 days, it is unlikely to improve with further observation. In cases with brainstem strokes, or other “high-risk” neurologic events for dysphagia, PEG may be placed even sooner.
7. For patients in a permanent vegetative state, the physician can offer to perform a PEG, but should recommend against it.
8. Patients with anticipated need for supplemental nutrition for < 8 weeks do as well with small-bore feeding tubes compared to PEG