Percutaneous endoscopic gastrostomy (PEG) feeding

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c2414 (Published 7 May 2010)
Cite this as: BMJ 2010;340:c2414

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  1. Matthew Kurien, specialty registrar 4 in gastroenterology1,
  2. Mark E McAlindon, consultant gastroenterologist2,
  3. David Westaby, consultant gastroenterologist3,
  4. David S Sanders, consultant gastroenterologist2
  1. 1Department of Gastroenterology, Chesterfield Royal Hospital, Chesterfield S44 5BL
  2. 2Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield S10 2JF
  3. 3Department of Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to: M Kurien matthew.kurien{at}chesterfieldroyal.nhs.uk
  • Accepted 26 April 2010

Summary points

  • Percutaneous endoscopic gastrostomy feeding presents complex moral and ethical problems

  • Gastrostomy feeding has mortality and nutritional benefits in carefully selected patients

  • There is no evidence of improved mortality in patients with dementia who are gastrostomy fed

  • Patient selection can be improved by the use of guidelines, protocols, and a multidisciplinary team approach

  • Patients referred for gastrostomy should be considered on the basis of their individual needs

  • After gastrostomy insertion, signs of a serious complication—pain on feeding and bleeding around or within the gastrostomy tube—should prompt urgent referral to a specialist

Percutaneous endoscopic gastrostomy (PEG) feeding, introduced into clinical practice in 1980,1 is now established as an effective way of providing enteral feeding to patients who have functionally normal gastrointestinal tracts but who cannot meet their nutritional needs because of inadequate oral intake.2 It is the preferred method of feeding when nutritional intake is likely to be inadequate for more than four to six weeks, and when enteral feeding is likely to prevent further weight loss, correct nutritional deficiencies, and stop the decline in quality of life in patients caused by insufficient nutritional intake.3 4 The beneficial effects of gastrostomy feeding on morbidity and mortality have been described only in certain subgroups of patients.5 6 Randomised studies in patients after stroke who received gastrostomy feeding have shown improved nutritional outcomes, higher likelihood of survival, and earlier discharge.6 7 However, gastrostomy tubes are increasingly being requested and inserted for indications where long term outcomes are uncertain.8 In this review we discuss the indications for, controversies surrounding, and complications of gastrostomy feeding and provide practical advice on the management of percutaneous endoscopic gastrostomies.

Sources and selection criteria

We searched the Cochrane database of systematic reviews and did a PubMed search (from January 1980 until January 2010) using the keywords “percutaneous endoscopic …

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