Percutaneous endoscopic gastrostomy (peg) in elderly:Medical indications, ethical limits

Abstract

Malnutrition is a frequent and highly relevant independent risk factor in elderly people with well-established significant clinical and economic consequences.Individual adequate nutritional intervention is based on the established stepwise treatment algorithm where artificial enteral nutrition via percutaneous endoscopic gastrostomy (PEG) tubes stands at the end of possible therapeutic options. Based on our modern guidelines and care standards, PEG placement is a well-established easy, safe, and highly effective procedure. Early supportive enteral nutrition via PEG is able to improve morbidity, mortality, and quality of life in a significant manner when individual indication is adequate and just in time. Our modern attitude toward the clinical benefits and adequate indications of PEG feeding has changed inafundamental way in recent years: feeding via PEG is not a terminal or even symbolic measure at the end of life but a clinically highly effective integral part of modern medical therapy and prevention and therefore requires an individual medical indication and ethical justification.In our modern understanding feeding via PEG isfrom its character supplemental, early as indicated, preventive, and in many cases temporary.