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Indications for percutaneous endoscopic gastrostomy insertion: ethical aspects
1Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Tel Aviv University, Petach Tikva, Israel. yniv@clalit.org.il
Digestive Diseases (Basel, Switzerland)
|February 5, 2003
Summary
Percutaneous endoscopic gastrostomy (PEG) offers benefits for specific conditions like head and neck cancer but may not improve outcomes for cachexia or short-life expectancy cancer. Careful consideration of patient selection and timing is crucial due to high mortality risks.
Area of Science:
- Medical Ethics
- Gastroenterology
- Geriatrics
Background:
- Percutaneous endoscopic gastrostomy (PEG) is a common method for long-term enteral nutrition.
- Its efficacy varies, and it may negatively impact end-of-life care.
Purpose of the Study:
- To discuss indications for PEG insertion.
- To explore ethical considerations surrounding PEG use.
- To define optimal patient selection and timing for PEG procedures.
Main Methods:
- Literature review and analysis of clinical outcomes.
- Examination of ethical principles and legal precedents.
- Discussion of patient characteristics and disease progression.
Main Results:
- PEG improves quality of life and survival in specific conditions (e.g., head and neck cancer, stroke).
- PEG offers no benefit in cachexia, anorexia, or advanced cancer with short life expectancy.
- Legal decisions mandate PEG for patients lacking self-determination (e.g., persistent vegetative state, dementia).
Conclusions:
- PEG insertion requires careful patient selection based on diagnosis and prognosis.
- A 30-60 day 'cooling off' period is recommended before PEG insertion due to high short-term mortality.
- Ethical and clinical factors must guide decisions regarding PEG use.