Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy?

Abstract

Percutaneous endoscopic gastrostomy is an established method to provide nutrition to patients with restricted oral uptake of fluids and calories. Here, we review the methods, indications and complications of this procedure. While gastrostomy can be safely and easily performed during gastroscopy, the right patients and timing for this intervention are not always chosen. Especially in patients with dementia, the indication for and timing of gastrostomies are often improper. In this patient group, clear data for enteral nutrition are lacking; however, some evidence suggests that patients with advanced dementia do not benefit, whereas patients with mild to moderate dementia might benefit from early enteral nutrition. Additionally, other patient groups with temporary or permanent restriction of oral uptake might be a useful target population for early enteral nutrition to maintain mobilization and muscle strength. We plead for a coordinated study program for these patient groups to identify suitable patients and the best timing for tube implantation.

Keywords: Gastrostomy, Nutrition, Dementia, Percutaneous endoscopic gastrostomy, Oncologic diseases, Endoscopy, Neurodegenerative disorders

Core tip: Gastrostomy is an established method for enteral nutrition of patients, but according to our experience and clinical studies, the wrong patients are often supplied with tube feeding. In addition to patients with clear indications, patients with advanced dementia receive gastrostomies for long-term-feeding. More data are needed for indication and timing of tube implantation, not only in demented patients.