The percutaneous endoscopic gastrostomy tube: medical and ethical issues in placement

Abstract

If no physiologic benefit is expected with PEG placement (anorexia-cachexia syndrome), the health care team has no obligation to offer or perform an intervention. This same principle would apply if intervention improves physiologic states but has no effect on quality of life (e.g., permanent vegetative state). Small-bore feeding tubes are cost effective and relatively safe for enteral feedings of up to 6-8 weeks. This is especially pertinent in the population with acute neurological deficits, in which prognostication on extent of impairment is best estimated by communication with neurologist. In the geriatric population there is no proved benefit in weight gain or markers of nutrition (albumin, prealbumin) in patients with malnutrition due to impaired oral intake.

A multidisciplinary approach to gastrostomy management in home enteral nutrition patients

“…Multidisciplinary teams are now aiming to ensure earlier tube insertion across a more appropriate patient demographic. 4 This is supported by Kurien et al's 1 reference to dementia no longer being a primary indicator for feeding tube placement. No data were provided by the author regarding the nutritional status of patients before entering into the home enteral nutrition programme.…”

Percutaneous endoscopic gastrostomy: an effective strategy for gastrostomy feeding in patients with dementia

“…Although it may appear that a patient is 'starving to death', this aspect of dementia should be viewed as part of the natural history of the disease. Although many experts have provided hypothetical guidelines for managing this clinical scenario, 7,8,17,[34][35][36][37] until recently, there have been no published data to suggest that changes in practice may improve the selection of patients.…”

High prevalence of malnutrition among patients with solid non-hematological tumors as found by using skinfold and circumference measurements

“…5 These conditions predispose such patients towards malnutrition, especially when there are frequent periods of chemotherapy treatment. 6 Because of weight variations that are associated with tumor size, other methods should be utilized to identify malnutrition, in addition to the weight-for-age and weightfor-height methods. Thus, the present study was carried out with the objective of evaluating and comparing two simple anthropometrical methods for assessing the nutritional status in children and adolescents with cancer, with comparison of the deficits between solid non-hematological and hematological malignancy diseases at the beginning of the induction therapy.…”