To PEG or not to PEG: a review of evidence for placing feeding tubes in advanced dementia and the decision-making process.

Percutaneous endoscopic gastrostomy (PEG) has evolved into a common low-risk procedure in current medical practice. Clinical evidence supporting the use of tube feedings in patients with advanced dementia is clearly lacking, yet PEG procedures continue to be performed in a large number of these cases. In fact, multiple studies have shown that feeding tubes seldom are effective in improving nutrition, maintaining skin integrity by increased protein intake, preventing aspiration pneumonia, minimizing suffering, improving functional status, or extending life. The decision-making process is complicated, however, and involves the clinician considering such issues as advance directives, ethical considerations, legal/financial concerns, emotional factors, cultural background, religious beliefs, and the need for a family meeting incorporating all of these principles.