Reply #24: Doctors Who Developed Feeding Tube Technique

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Doctors Who Developed Feeding Tube Technique Didn't Envision Schiavo Dilemma

The doctors who created the current technique for inserting feeding tubes into patients said the procedure has gone far beyond its original purpose of helping infants and children who couldn't swallow. Insertion of feeding tubes required major surgery until Dr. Jeffrey Ponsky and Dr. Michael Gauderer developed their technique in 1979. Today, it's used more than 250,000 times a year and has become an integral part of end-of-life care.

Ponsky said he and Gauderer never imagined the procedure would lead to a "massive ethical dilemma" such as the one involving Terri Schiavo, the brain-damaged Florida woman whose care has become the subject of a protracted legal battle. Too often, Ponsky said, the tubes are too often used in patients with no potential for recovery. "Once they're in, it's so emotionally difficult to take it out and let someone die," said Ponsky, who heads the surgery department at Case Western Reserve University.

Still, Ponsky believes that Schiavo should remain connected to a feeding tube if her family is willing to care for her. The tube was removed March 18 on a judge's order that agreed with Schiavo's husband, Michael, who has said she has no hope for recovery and wouldn't want to be kept alive artificially. Her parents believe she could improve. Doctors have said she would probably die within a week or two of the tube being pulled.

Gauderer, director of surgery at Greenville Children's Hospital in South Carolina, said it wouldn't be appropriate for him to give an opinion on the Schiavo case, but he believes the government shouldn't intervene. "This is something that needs to be decided at the family level," he said. Gauderer and Ponsky first performed their technique - percutaneous endoscopic gastrostomy, or PEG - in 1979 on a 4-month-old boy at Rainbow Babies & Children's Hospital in Cleveland. They inserted a needle into the baby's stomach and passed a thread through that was pulled out the mouth by an endoscope. A feeding tube was attached to the thread then drawn through the throat, into the stomach and pulled out through the belly.



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