January 30, 2012

PEG Tubes Used Appropriately Can Be Lifesaving

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Stomach Tubes to Feed Elderly Often Unnecessary, May Be Harmful

Feeding tubes surgically implanted into the stomach are coming under growing criticism in medical care for the elderly, even as their use among the frail, terminally ill and often demented patients has become commonplace.

Best Feed Tube Decisions Require Tough Choices

For physicians, this is routine and uncomplicated surgery. For the families of ailing seniors, it is yet another medical procedure fraught with uncertainty that arouses disturbing questions and fears about life and death, often accompanied by feelings of guilt and family turmoil.

Often Futile Procedure Remains Common

No one can point to a single culprit or clear explanation for why the medical profession continues the controversial and routine practice of surgically implanting feeding tubes in stomachs of dying, elderly patients.

But a lot of people in healthcare industry are reaping the benefit. Like hospitals. And nursing homes. And the global medical technology giants.

While criticism of through-the-stomach feeding tubes has revolved around their use in frail elderly people, the device is widely accepted as crucial to medical care in a number of other circumstances.

Little controversy surrounds the use of percutaneous endoscopic gastronomy (PEG) tubes in patients with long-term nutritional needs but good prospects for recovery from whatever condition has interfered with their ability to eat.

The PEG is often considered the safest method for feeding in connection with cancers near or in the digestive system, or cancer conditions and treatments that block the upper airway so that feeding through the nose is not possible. People battling head and neck cancer, cancer of the esophagus or ovarian cancer may not be able to eat normally during a prolonged treatment period that is likely to involve surgery, chemotherapy and/or radiation. Thus, a PEG tube may be the best route for regular nutrition as attention focuses on eradicating the cancer.

Use of  a PEG tube may be noncontroversial in connection with recovery from burns, to deal with certain long-term digestive disorders and for head injury and brain tumor patients when normal eating will be disrupted for a long period. Patients living with chronic neurological illnesses such as amyotrophic lateral sclerosis (ALS, better known as Lou Gehrig’s disease) also may benefit from PEG tube feeding.

Use of stomach tubes in connection with neurological conditions in the elderly, including strokes and dementia, are the most controversial. PEGs are not recommended for acutely ill patients, patients with short life expectancy and patients with severe coughing.

A group of medical experts in Rochester, N.Y., have developed guidelines for making decisions for end-of-life care. They say that for some categories of patients, PEG placement may prolong life but will not necessarily improve the quality of life; and that in many circumstances, a PEG tube is unlikely to improve either length or quality of life.

Most likely to benefit are stroke patients with swallowing problems who previously were in good health: up to 25 percent of such patients regain their swallowing capabilities – although the other 75 percent are “not likely to have improved quality of life and/or functional status,” the group finds.

These experts also say PEG tubes may be helpful in giving family members and caregivers “hope for future improvement.”

And even when improvement is not expected, as with late-stage ALS patients or patients in what is termed “a persistent vegetative state,” PEGs can extend life and give family and caregivers “additional time to adjust to possibility of impending death,” the group says.

 

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