ESPEN guidelines on artificial enteral nutrition--percutaneous endoscopic gastrostomy (PEG)

Based on many recently published clinical studies our earlier view of PEG being primarily linked to advanced stages of mainly malignant diseases has switched to support for earlier decision making in a large variety of potential patients with different underlying diseases. Patients with advanced cancer, end-stage diseases or advanced dementia are not usually considered appropriate candidates for artificial feeding via PEG tubes. Overall published data support an individualized but critical and restrictive approach to PEG feeding in such patients. In experienced hands PEG placement and feeding is a safe and highly effective procedure if modern devices are used and established standards are adhered to. Nevertheless, decision making is still difficult in many cases having always an individual character. Prospective clinical studies have shown, that guidelines help to improve the appropriateness of patients selection and play a proactive role in the decision making for medically adequate PEG insertion with a consecutively improved outcome. Enteral nutrition via a tube system inserted with endoscopic guidance is an efficient, highly effective and easy to use technique, associated with a low rate of complications, which allows the maintenance of adequate enteral nutrition of patients who are unable to ingest sufficient nutrients orally. Clinical studies have demonstrated the high level of acceptance by patients and the marked improvement in nutritional status and general well being of such patients. In order to prevent deterioration of nutritional status and to improve their overall quality of life, the decision whether or not to use an enteral tube system for feeding should be taken at a much earlier stage and should be more frequently positive in appropriate patients who fulfil the above mentioned and discussed criteria.