Staff find it harder to stop feeding patients with a gastrostomy

EDITOR,—The initial findings of B Norton and colleagues' study comparing percutaneous endoscopic gastrostomy with nasogastric tube feeding after acute dysphagic stroke seem to suggest a better prognosis for patients fed through a gastrostomy.1 I welcome the authors' intention to study the effects of this procedure on the long term quality of life and will be interested to learn of their findings. I would ask them to pay particular attention to how we should deal with those patients who do not make a good recovery and who face the prospect of long term feeding through their gastrostomy.

Already this is causing problems in continuing care facilities, where decisions may need to be taken on whether to continue such feeding when long term recovery does not occur. Aside from the possible legal aspects of stopping feeding, staff find it harder to stop feeding patients with a gastrostomy than patients with a nasogastric tube. It is technically simple to remove a nasogastric tube, but removing a gastrostomy requires anaesthesia. Surgery for this group of patients is not appropriate at this stage in their care. It may then become difficult for staff to continue caring for these patients while not using the “permanent” gastrostomy tube.

If the use of gastrostomy after dysphagic stroke is to become routine we must more openly recognise and deal with the ethical and emotional dilemmas that may arise as a consequence.