Percutaneous Endoscopic Gastrostomy Does Not Prolong Survival in Patients With Dementia

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Abstract
PERCUTANEOUS endoscopic gastrostomy (PEG) is used widely for gastrointestinal tract access to provide artificial feeding. A retrospective cohort study1 of 81 105 Medicare beneficiaries revealed an in-hospital mortality of 15.3% for all those who underwent gastrostomy. A similar Department of Veterans Affairs study2 reported an in-hospital mortality of 23.5% in 7369 patients with PEG tubes. Percutaneous endoscopic gastrostomy tube placement frequently is requested to address problems of advanced dementia. These patients present with difficulty eating or swallowing, decreased consciousness, and weight loss.3 Despite lack of evidence to support the use of artificial nutrition by tube in patients with severe dementia,4 it is assumed that the alternative—no artificial feeding—is worse. Three studies have attempted to compare outcome in similar patients with and without gastric artificial feeding. One of these reports5 found a modest prolongation of life in nursing home patients with swallowing disorders who received a feeding tube compared with similar patients not receiving a feeding tube. Conversely, a similar study6 found a worse outcome in nursing home patients who received a feeding tube compared with those who did not. A third study7 found no difference in survival. Because the patients in the previously mentioned studies were considered similar only because of similar findings on a Health Care Financing Administration–required minimum data set form, it is not clear whether any study was truly comparing equivalent patients.

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