Is it ethical to provide enteral tube feedings for patients with dementia?
The development of the PEG (percutaneous endoscopic gastrostomy) tube changed enteral tube feedings dramatically.1 Prior to the creation of the PEG tube, enteral feeding options were either a nasogastric tube (NGT) or a surgically-placed gastrostomy tube. NGTs are associated with a high risk of pressure sores and aspiration. Surgically-placed gastrostomy tubes have a high procedural complication rate secondary to the need for anesthesia. The PEG tube has a significantly lower risk for complications compared with other forms of feeding tube placement.2 Originally, the PEG tube was indicated primarily in brain-damaged children and children with swallowing disorders. Over the past 30 years, the application of the PEG tube has grown to include other medical conditions that require long-term enteral access.1 One indication that has become common is compromised nutritional status in patients with dementia. This is a controversial application because of the lack of clear evidence supporting
