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Practice Clinical updates

Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5311 (Published 22 January 2019) Cite this as: BMJ 2019;364:k5311

Re: Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management

Farrag et al’s article describing the practical aspects of gastrostomy feeding provides an excellent summary for clinicians 1. Our research found that the decision to undergo gastrostomy in patients with motor neurone disease is a difficult process with individual variations and wishes 2. As a result, patients often put off having a gastrostomy tube inserted although delaying gastrostomy may have serious consequences as the risk of the procedure increases and weight loss is often irreversible 3.

Information provision by healthcare professionals is important to help patients and their families make informed decisions. We supported the development of an evidence-based website www.mytube.mymnd.org.uk which was made by, and for patients and their informal carers. It provides practical information about living with, and caring for a tube. It uses videos to describe patient and carers’ experiences when accepting or declining enteral feeding. We encourage clinicians to signpost to this website early in the decision making process. Whilst the focus is on motor neurone disease some of the content may be relevant to anyone looking to gain more information about gastrostomy feeding, particularly in neurological diseases.

1. Farrag K, Shastri YM, Beilenhoff U, Aksan A, Stein J. Percutaneous endoscopic gastrostomy (PEG): a practical approach for long term management. BMJ. 2019;364:k5311. doi:10.1136/bmj.k5311.
2. Stavroulakis T, Baird WO, Baxter SK, Walsh T, Shaw PJ, McDermott CJ. Factors influencing decision-making in relation to timing of gastrostomy insertion in patients with motor neurone disease. BMJ Support Palliat Care. 2013;4(1):57-63. doi:10.1136/bmjspcare-2013-000497.
3. ProGas Study Group. Gastrostomy in patients with amyotrophic lateral sclerosis (ProGas): a prospective cohort study. Lancet Neurol. 2015;14(7):702–700. doi:10.1016/S1474-4422(15)00104-0.

Competing interests: No competing interests

04 February 2019
Esther Victoria Hobson
NIHR clinical lecturer and honorary specialty register in neurology
Soreny C, Stavroulakis T, White S, McDermott CJ
Sheffield Institute for Translational Neuroscience, University of Sheffield and Sheffield Teaching Hospitals NHS Trust
Sheffield Institute for Translational Neuroscience, 385a Glossop Road, Sheffield, S10 2HQ