Percutaneous Endoscopic Gastrostomy in the Enteral Feeding of the Elderly

Abstract

s u m m a r y Today we are faced with an aging society that may develop malnutrition because of dysphagia related to dementia, stroke, and malignancy seen often in the elderly. The preferred form of nutritional supplementation for this group is enteral nutrition, and the most appropriate long-term method is by use of a gastrostomy. Percutaneous endoscopic gastrostomy (PEG) was first introduced in 1980 as an alternative to the traditional operative procedure and rapidly became the preferred procedure. In geriatric patients, the principal indications are neurological dysphagia and malnutrition, related to an underlying disease or anorexia-cachexia in very elderly. PEG is contraindicated in the presence of respiratory distress, previous gastric resection, total esophageal obstruction, coagulation disorders and sepsis in the elderly. Common complications include wound infection, leakage, hemorrhage, and fistula in the general population, but aspiration pneumonia is the major case of death in this group. Risks and complications of PEG must be discussed with patients and their families; and the decision for percutaneous endoscopic gastrostomy insertion should only be made after careful consideration and discussion between managing physicians, allied health professionals, and the patient and/or family. Four ethical principles may help make feeding decisions: beneficence, non-maleficence, autonomy and justice. Attentive long-term care after tube replacement is mandatory. Acceptance of percutaneous endoscopic gastrostomy placement by patients and their families tends to increase once favorable outcomes are offered.

Dysphagia: implications for older people

“…157,158,[160][161][162][163][164][165][166] The direction of discussions in this literature is that there remains much to do in clarifying the evidence base around decisions that need to be made -for instance extensive literature is available in relation to outcomes around PEG placement, 158,164 but how this is applied to specific populations or individuals (imminent vs nonimminent death; lacking capacity or not; different medical aetiologies; different co-morbidities present) awaits definitive answers. Decisions around nasogastric or PEG feeding and withdrawal of feeding support are particularly fraught areas.…”

Experiences of Percutaneous Endoscopic Gastrostomy in our Neurology Intensive Care Unit Patients

“…Several methods have been developed to place feeding tubes to the stomach or jejunum for patients with no prospect of transition to oral feeding within 3 days (11,12,13,14). In the late 1980s, PEG procedures gained widespread acceptance, with increasingly higher popularity since then, mainly based on the rapidity and safety of the procedure compared with other surgical approaches (9,15). Long-term percutaneous enteral feeding is used in patients with life expectancy who have no chance of returning to oral feeding.…”

Advantage of Long Ileus-tube Placement by Gastrostomy for Treating Patients with Refractory Intestinal Obstruction

“…Due to the low incidence of complications 4-33 , endoscopic PEG is currently the most widely used method for long-term ileus tube insertion and maintenance ; however, the mortality and morbidity rates associated with this procedure are 1-2 and 3-12 , respectively 16 . Herein, we achieved safe and easy placement of an ileus tube via gastrostomy using a commercially available gastrostomy kit.…”