Difficulties with percutaneous endoscopic gastrostomy (PEG): a practical guide for the endoscopist.
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) is a widely used and effective means of providing long-term nutrition in patients with inadequate oral intake. The demand for this intervention has risen steadily since the early 1990s. Endoscopists who perform PEG insertion have become increasingly concerned about inappropriate use of this intervention.


OBJECTIVE
This review addresses the particular areas of difficulty, namely, dementia, stroke, aspiration pneumonia and use of PEG to facilitate discharge from hospital.


METHODS
A Pubmed literature search and the author's personal experience.


CONCLUSIONS
Strategies for improving patient selection and a practical approach to difficult decisions are described.
Cork University Hospital, Wilton, Cork, Ireland. Seamus.omahony@hse.ie
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O'Mahony
D003657:Decision Making; D003704:Dementia; D034462:Dissent and Disputes; D020776:Endoscopes, Gastrointestinal / Q000941:ethics*; D004750:Enteral Nutrition; D005190:Family; D005774:Gastrostomy / Q000009:adverse effects / Q000193:education / Q000941:ethics* / Q000379:methods; D006801:Humans; D018447:Medical Futility / Q000941:ethics*; D009752:Nutritional Status; D018579:Patient Selection / Q000941:ethics; D011015:Pneumonia, Aspiration; D020521:Stroke; D020458:Third-Party Consent