Opinion Review
Copyright ©The Author(s) 2020.
World J Gastroenterol. May 28, 2020; 26(20): 2464-2471
Published online May 28, 2020. doi: 10.3748/wjg.v26.i20.2464
Table 1 Basic considerations for percutaneous endoscopic gastrostomy implantation and typical access types
Basic considerations for PEG implantation
Is oral nutrition - for whatever reason - so inadequate that intervention is justified?
Is enteral nutrition likely to be necessary for at least 3 wk?
Is the intestine distal to the access path functional?
Are risk factors for complications absent?
Is the anatomy suitable for PEG?
Is compliance sufficient for PEG handling (feeding in (half) upright position, infection prophylaxis, mobilization of the PEG tube, etc.)?
Typical access types
Pull-PEG (Ponsky-Gauderer)After diaphanoscopy, primary puncture with a trocar followed by pulling the tube with a thread through the esophagus
Push-/Introducer-PEG (Russell)With diaphanoscopy, primary gastropexy followed by direct introduction of a balloon-fixed tube
Table 2 Accepted and data-supported indications for percutaneous endoscopic gastrostomy (for references see text)
Main disease groupsDiagnosis/reason for dysphagia
CancerHead and neck cancer
Pharyngeal cancer
Esophageal carcinoma
Cancer with functional bowel obstruction (percutaneous endoscopic gastrostomy used as a decompression measure)
Neurodegenerative disordersStroke
Amyotrophic lateral sclerosis
Multiple sclerosis
Severe brain damage from various reasons (trauma, persistent vegetative state, psychomental retardation, etc.)
Table 3 Studies of enteral nutrition with dementia patients in recent years
Ref.DesignNumber of patients with dementiaMain resultsStudy problems/Appraisal
Higaki et al[15], 2008Retrospective cohort study311 (143 with and 168 w/o dementia)No significant differences in survivalNo controls w/o PEG
Suzuki et al[28], 2012Observational study1353Significantly more benefit in patients with early dementiaEndpoint “Level of independent living of demented elderly” not validated, no controls
Ticinesi et al[34], 2016Observational study184 (54 with PEG, 130 w/o PEG)Survival with PEG significantly worseSelection 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], 2016Retrospective observational study46 (only CDR 2 and 3)Low albumin, transferrin and cholesterol as predictors for poor survivalNo controls
Cúrdia et al[36], 2017Prospective cohort study, uncontrolled26 (out of 60 in the whole cohort)Significant decrease in hospitalization and visits to ER, > 50% healing of pressure ulcersOnly internal controls, no dementia grading
Ayman et al[37], 2017Retrospective cohort165, control group with PEG for other reasonsSignificantly shorter survival in dementia patientsNo dementia control group, no dementia rating
Gingold-Belfer et al[38], 2017Retrospective Cohort, uncontrolled189Albumin level associated with longer survival (at baseline as well as during observation)No control group, no dementia rating
Van Bruchem-Visser et al[39], 2019Retrospective cohort42 (out of 303 in the whole cohort), no controls w/o PEGSurvival with PEG significantly shorter in patients with dementiaSelection bias, no dementia rating, PEG-indication partly unclear
Table 4 Additional patient groups with a lack of data but potential benefit if the timing of gastrostomy is correct
Chronic pancreatitis
COPD with manifest or imminent undernutrition/cachexia
Severe eosinophilic esophagitis
Severe ulcerative reflux disease
Cancer with undernutrition syndrome
(Mild to) moderate dementia