Is PEG worth the trouble??

PEG provides durable access for enteral nutrition, can generally be performed quickly and usually with only conscious sedation, and continues to be one of the most common procedures referred to gastroenterologists. It represents a dramatic improvement over surgical gastrostomy.However, a large number of PEG tubes continue to be placed in patients for whom the benefit is questionable or limited at best.

These patients are exposed to a procedure with a procedure-related mortality of 0.5% and morbidity of 17% while they are unlikely to derive benefit. It is difficult to think of other medical procedures with as unfavorable risk-benefit ratios that are performed as commonly as PEG. The moral and ethical uncertainty facing patients, surrogates, and physicians when confronted with the choice to withhold artificial nutrition and hydration likely drives the decision to place PEG tubes in many patients who are unlikely to derive benefit. It remains to be seen if interventions such as improved physician education about the limitations of PEG tubes to improve outcome, the increased use of palliative care teams, the increased use of advanced directives, or overall education of physicians and the public about end-of-life issues, will lead to a decrease in the placement of PEG tubes in patients with end-stage illness... I have copied the conclusions of this article but worth reading.