Question
What are some potential benefits and risks of PEG tube use?
Answer
Certain patient populations benefit from PEG placement. There is evidence to support benefit for head and neck cancer patients, patients with ALS, stroke patients, patients in a catabolic state with reversible illness, such as trauma patients, and a few other patient populations. Patients with esophageal motility issues or obstruction in some HIV patients. Therefore, there is evidence to support the use of PEG tube in some patient populations, and it's not always because it improves mortality. But, for some patients a PEG can improve quality of life and comfort.
Clearly, benefits should outweigh the risks and burdens. Although the risks are relatively low, there are risks associated with PEG tube placement, such as infection, tube dislodgement, aspiration pneumonia, reaction to anesthesia when placing the PEG and refeeding syndrome.
There are some burdens associated with PEG tube placement, which are not often discussed. For example, can the patient afford to pay for enteral supplies? Not all insurance companies pay for them, and not all patients actually have reliable access. Some patients have to actually decide if they buy food for their family or for a spouse who requires tube feedings.
Also, there are a number of patients whose family cannot manage PEG tubes, and will then need to stay in a nursing home in order to have the feeding tube. Most patients would rather be at home with their families. There are significant risks and burdens associated with staying in a nursing home, so we have to carefully consider placement. We cannot justify placement without convincing objective clinical evidence that there is going to be some patient benefit.
Ms. Wigginton earned her Master's Degree in Speech Language Pathology from Murray State University in 1991. She is a clinician at the University of Kentucky Voice and Swallow Clinic and has worked in academic medicine for over 14 years. Her areas of expertise include alaryngeal communication, evaluation and treatment of communication and swallowing disorders in head and neck cancer patients and neuro-voice and swallowing disorders.
