Percutaneous Endoscopic Gastrostomy Does Not Prolong Survival in Patients With Dementia

Background: Artificial feeding by a percutaneous en-doscopic gastrostomy (PEG) tube in patients with de-mentia has increased since the introduction of the en-doscopic method of tube placement. Few studies have documented survival benefit from this intervention. This report reviews our experience with PEG tube place-ment for feeding patients with dementia. Methods:All consultations for PEG tube placementwere evaluated by a certified nutrition support nurse (L.M.M.) in consultation with a member of the gastroenterology physician staff (T.O.L.) for 24 months. Evaluation in-cluded the attainment of a brief medical history, a physi-cal examination, and a review of comorbid conditions, laboratory variables for nutrition status, and bleeding risk. Interviews with patients or surrogates were conducted, including an explanation of the risks and benefits of PEG tube placement. A Kaplan-Meier survival curve was used to compare the median survival between patients with dementia who received a PEG tube and patients with de-mentia in whom PEG tube placement was refused. Results: We received 41 consultations for PEG tube placement in patients with dementia. Percutaneous en-doscopic gastrostomy was performed in 23 patients; 18 patients met the medical criteria for PEG tube place-ment, but surrogates refused placement. Themedian sur-vival for the 23 patientswho underwent PEGwas 59 days; the median survival for the 18 patients who did not un