Decreasing Use of Percutaneous Endoscopic Gastrostomy Tube Feeding in Japan

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 66; no. 7; pp. 1388 - 1391
• Main Authors: Komiya, Kosaku, Usagawa, Yuko, Kadota, Jun‐ichi, Ikegami, Naoki
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2018
• Subjects: Aged; Aged, 80 and over; Cross-Sectional Studies; Decision Making; Earthquakes; Endoscopy; Endoscopy, Gastrointestinal - statistics & numerical data; Enteral Nutrition - statistics & numerical data; Feeding; Female; Geriatrics; Humans; Hyperalimentation; Intravenous administration; intravenous hyperalimentation; Intubation, Gastrointestinal - statistics & numerical data; Long-Term Care; Male; Ostomy; percutaneous endoscopic gastrostomy; Practice Patterns, Physicians' - statistics & numerical data; tube feeding; Japan; percutaneous endoscopic gastrostomy; tube feeding; intravenous hyperalimentation
• DOI: 10.1111/jgs.15386
• ISSN: 0002-8614

OBJECTIVES To identify trends in percutaneous endoscopic gastrostomy (PEG) tube placement and intravenous hyperalimentation (IVH) in nonhospital settings (as a potential alternative to tube feeding for nutrition) and to summarize published reports concerning the decision‐making process for PEG placement. DESIGN National survey and systematic review. SETTING Japan. PARTICIPANTS All Japanese people. MEASUREMENTS Data on numbers of individuals with a PEG tube and IVH were obtained from the website of the Japanese Ministry of Health, Labour, and Welfare and published reports concerning the decision‐making process for PEG placement in Japan were summarized. RESULTS The number of PEG tube placements peaked in 2007 and has been decreasing since Japan experienced the Great East Japan Earthquake in 2011. A further decline was seen in 2015 after the Japanese Ministry of Health, Labour and Welfare revised the fee schedule in 2014. More than half of individuals who had tubes were aged 80 and older during the years observed. In contrast, the number of individuals receiving IVH was lowest in the same year as PEG tube placement peaked and has been increasing ever since. Four studies reported that the decision‐making process included consideration of not only the underlying disease, but also the individual's age and social barriers and the physician's personal philosophy. CONCLUSION The number of PEG tube placements has been decreasing since its peak in 2007, and the number of individuals receiving IVH has been increasing. Many factors influence the decision‐making process for PEG tube placement. Physicians in Japan may be realizing that there is little evidence to support the use of tube feeding in frail elderly adults.