Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy?

Table 3 Studies of enteral nutrition with dementia patients in recent years

Ref.	Design	Number of patients with dementia	Main results	Study problems/Appraisal
Higaki et al[15], 2008	Retrospective cohort study	311 (143 with and 168 w/o dementia)	No significant differences in survival	No controls w/o PEG
Suzuki et al[28], 2012	Observational study	1353	Significantly more benefit in patients with early dementia	Endpoint “Level of independent living of demented elderly” not validated, no controls
Ticinesi et al[34], 2016	Observational study	184 (54 with PEG, 130 w/o PEG)	Survival with PEG significantly worse	Selection bias, no basic data for PEG-group vs non-PEG-group, patients with advanced dementia had better results compared to those with early dementia
Nunes et al[35], 2016	Retrospective observational study	46 (only CDR 2 and 3)	Low albumin, transferrin and cholesterol as predictors for poor survival	No controls
Cúrdia et al[36], 2017	Prospective cohort study, uncontrolled	26 (out of 60 in the whole cohort)	Significant decrease in hospitalization and visits to ER, > 50% healing of pressure ulcers	Only internal controls, no dementia grading
Ayman et al[37], 2017	Retrospective cohort	165, control group with PEG for other reasons	Significantly shorter survival in dementia patients	No dementia control group, no dementia rating
Gingold-Belfer et al[38], 2017	Retrospective Cohort, uncontrolled	189	Albumin level associated with longer survival (at baseline as well as during observation)	No control group, no dementia rating
Van Bruchem-Visser et al[39], 2019	Retrospective cohort	42 (out of 303 in the whole cohort), no controls w/o PEG	Survival with PEG significantly shorter in patients with dementia	Selection bias, no dementia rating, PEG-indication partly unclear

w/o: Without; ER: Emergency room; PEG: Percutaneous endoscopic gastrostomy.