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

Area of Science:

• Geriatrics
• Palliative Care
• Medical Ethics

Background:

• Percutaneous endoscopic gastrostomy (PEG) tubes are indicated for severe swallowing disorders, often linked to neurological conditions with uncertain prognoses.
• These tubes are typically inserted when swallowing difficulties are expected to persist for 2-4 weeks.

Observation:

• Three elderly patients (76, 81, 80 years) with Parkinson's disease or stroke received PEG tubes before transfer to a nursing home.
• Two patients, completely passive and incontinent, had PEG tubes removed after determining they no longer served a medical purpose, leading to death under sedation.
• A third patient died of untreated pneumonia due to uncertainty regarding prognosis and quality of life, highlighting challenges in decision-making.

Findings:

• PEG tube insertion, while intended for nutritional support, can inadvertently prolong suffering in patients with severe neurological impairments.
• The decision to withdraw PEG tube support requires careful consideration of treatment goals and patient prognosis.
• Lack of clear evaluation points for PEG tube necessity can lead to prolonged, potentially futile treatment.

Implications:

• Clearer characterization of PEG tube insertion as a procedure with defined goals is needed.
• Regularly evaluating the attainment of PEG tube objectives is essential for ethical patient care.
• Establishing criteria for PEG tube continuation or withdrawal can prevent unnecessary suffering and improve end-of-life care.