Gastric Tubes (G Tube or PEG Tube)—The gastric tube is a permanent (but reversible) type of feeding tube.
A well-organized nutrition support team consists of a physician, nurse, and nutritionist. The benefit of PEG tube placement in this patient group remains controversial. The PEG tube generally lasts for 1-2 years, but can occasionally become blocked or damaged. G tube placement requires an interventional surgical procedure in which the G tube is advanced from the abdominal skin directly into the stomach. There is no evidence that PEG feeding actually improves quality of life. Care must be taken to keep the tube insertion site clean to avoid infection. These patients present with difficulty eating or swallowing, decreased consciousness, and weight loss. The mean time from PEG insertion until PEG removal was 2.19 years (range, 1.96–2.62 years) for the three patients who experienced delayed closure of the gastrocutaneous fistula and 0.88 years (range, 0.1–1.44 years) for patients with spontaneous closure of the fistula. Percutaneous endoscopic gastrostomy tube placement frequently is requested to address problems of advanced dementia. The experts largely agree that PEG tube feeding is of little benefit for most patients with a limited life span or with dementia.
For the 216 remaining patients, life expectancy without the feeding tube was a median of 1–2 months and it increased to an anticipated life expectancy of a median of 1–3 years with the feeding tube in place. What is involved in a PEG procedure?
In patients with limited life expectancy there should be good indications for PEG placement, as feeding may merely slow the rate of decline or prolong an imminent death.
The tubes can be readily replaced, or removed if no longer required. When a patient is being considered for PEG tube placement, the patient’s life expectancy and quality of life after the tube is placed should be considered to determine if placement of a feeding tube is appropriate. PEG tube insertion requires an experienced endoscopist, surgeon, and an anesthetist; however, after placement of the tube, management requires an entire nutrition support team. 1,2,5,9-11 In patients with dementia, PEG tube feeding rarely contributes to better nutritional status or longer life, nor does it minimize suffering or improve functional status. The tube is kept in place inside the stomach with a coiled wire or with a small air-inflated balloon.
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