[Percutaneous endoscopic gastrostomy catheter: a trap without escape?]

Three patients, a 76-year old man with Parkinson's disease and two women aged 81 and 80 years, both of whom had experienced a stroke, were transferred from a hospital to a nursing home following the insertion of a percutaneous endoscopic gastrostomy (PEG) catheter. The worldwide accepted indication for the insertion of a PEG catheter is: the existence of serious swallowing disorders which are expected to last for more than 2-4 weeks and are mostly connected with a neurological disorder with an uncertain prognosis. However, this procedure may lead to a fairly common adverse effect, although never acknowledged as such: the unintended prolonging of a patient's suffering. This was also the case for the patients described. Eventually in the case of the first two patients, who were completely passive and incontinent for both urine and faeces, the catheter was removed once it had been established (in discussions with those responsible for treatment and the family) that it no longer fulfilled its purpose as a medical treatment. The patients died under adequate sedation. In the case of the third patient, those responsible for the treatment were unsure about the unfavourable prognosis and the absence of a quality of life; she later died from an untreated pneumonia. In order to reduce the frequency with which these serious consequences occur, it is suggested that the insertion of a PEG catheter should be characterised as a medical procedure the purpose of which should be clearly stated. Whether or not this purpose has been attained can be evaluated at given points in time so that the treatment can either be continued, or withdrawn.