Percutaneous Endoscopic Gastrostomy: Use and Abuse in Clinical Practice
DOI:
https://doi.org/10.17140/GOJ-1-110Keywords:
Percutaneous Endoscopic Gastrostomy (PEG), Indications, Contraindications, Clinical practice, Ethical IssuesAbstract
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.
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