Opinion Review
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2020; 26(20): 2464-2471
Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2464
Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy?
Christoph G Dietrich, Konrad Schoppmeyer
Christoph G Dietrich, Medical Clinic, Bethlehem-Gesundheitszentrum Stolberg/Rhld., Stolberg D-52222, Germany
Konrad Schoppmeyer, Medical Clinic II, Euregio-Klinik Nordhorn, Nordhorn D-48529, Germany
Author contributions: Dietrich CG developed the concept of this review, and both authors wrote the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Christoph G Dietrich, MD, PhD, Chief Doctor, Med. Klinik, Bethlehem-Gesundheitszentrum Stolberg/Rhld., Steinfeldstr. 5, Stolberg D-52222, Germany. dietrich@bethlehem.de
Received: January 4, 2020
Peer-review started: January 4, 2020
First decision: March 21, 2020
Revised: April 30, 2020
Accepted: May 15, 2020
Article in press: May 15, 2020
Published online: May 28, 2020

Percutaneous endoscopic gastrostomy is an established method to provide nutrition to patients with restricted oral uptake of fluids and calories. Here, we review the methods, indications and complications of this procedure. While gastrostomy can be safely and easily performed during gastroscopy, the right patients and timing for this intervention are not always chosen. Especially in patients with dementia, the indication for and timing of gastrostomies are often improper. In this patient group, clear data for enteral nutrition are lacking; however, some evidence suggests that patients with advanced dementia do not benefit, whereas patients with mild to moderate dementia might benefit from early enteral nutrition. Additionally, other patient groups with temporary or permanent restriction of oral uptake might be a useful target population for early enteral nutrition to maintain mobilization and muscle strength. We plead for a coordinated study program for these patient groups to identify suitable patients and the best timing for tube implantation.

Keywords: Gastrostomy, Nutrition, Dementia, Percutaneous endoscopic gastrostomy, Oncologic diseases, Endoscopy, Neurodegenerative disorders

Core tip: Gastrostomy is an established method for enteral nutrition of patients, but according to our experience and clinical studies, the wrong patients are often supplied with tube feeding. In addition to patients with clear indications, patients with advanced dementia receive gastrostomies for long-term-feeding. More data are needed for indication and timing of tube implantation, not only in demented patients.