Percutaneous endoscopic gastrostomy (PEG), in elderly patients with dementia and anorexia

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Luigi Sivero
Donato Alessandro Telesca
Maurizio Gentile
Giovanni Aprea
Guido Massa
Giovanni Cestaro
Michele Danzi
Cesare Formisano

Abstract

BACKGROUND AND AIMS: Ethical and medico-legal issues reviews of Percutaneous Endoscopic Gastrostomy (PEG) placement in elderly patients is an important topic of international medical literature. PEG is often inappropriately placed in patients with not spontaneous oral feeding intake, cause of unrealistic expectations. We performed a critical review of the literature for placement of PEG in geriatric patients.


METHODS: A literature review was performed about the positioning of the PEG in geriatric patients with dementia and severe anorexia. This assessment has served to develop an algorithm that would be able to provide adequate indications for PEG placement in this patient population.


RESULTS: We obtained appropriate indications about PEG placement, below: 1) Esophageal obstructions (like esophageal or neck cancer) 2) neurological deficits correlated dysphagia (like ictus sequelae) 3) refusal to swallow without concomitant terminal illness (like protracted pseudo dementia caused by severe depression) 4) chronic gastric decompression in patients with benign/malignant obstruction who do not wish or can’t have a nasogastric tube placed.


CONCLUSIONS: When compared with controls matched for age, elderly patients with cognitive impairment who have feeding gastrostomy do not demonstrate improved survival.

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How to Cite
Luigi Sivero, et al. “Percutaneous Endoscopic Gastrostomy (PEG), in Elderly Patients With Dementia and Anorexia”. Annali Italiani Di Chirurgia, vol. 89, no. 4, July 2018, pp. 305-8, https://annaliitalianidichirurgia.it/index.php/aic/article/view/1099.
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