How long can I “put off” getting a PEG?

A PEG tube is necessary when a patient has a severe swallowing disorder. Repeated and regular aspiration and weight loss are typical consequences of a swallowing disorder. If any of these consequences of a swallowing disorder are present, the placement of a PEG tube should not be delayed.

In addition, respiratory function must be taken into account: If respiratory capacity is reduced (RC < 50%), the surgical procedure to place a PEG tube may be associated with increased risks. Respiratory dysfunction is therefore another reason not to delay the placement of a PEG tube. It is advisable to follow the physician’s recommendation for PEG placement. At the same time, PEG placement is an invasive procedure that requires the patient’s informed consent. Thus, within a palliative care approach, the decision not to perform a PEG placement can be made very deliberately. In this context, the decision not to perform a PEG placement should not be understood as “postponement,” but rather as a limitation of treatment and a fundamental decision to forgo invasive treatment.

The decision to have a PEG placed, determining the appropriate timing, and avoiding an unfavorable postponement of the PEG placement are common and important topics in a trusting doctor-patient dialogue regarding ALS.