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Creators of tube technique didn't foresee dilemma

CLEVELAND -- The doctors who created the technique used to insert feeding tubes into patients said the procedure has gone far beyond its original purpose of helping infants and children who could not 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 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.

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 would not want to be kept alive artificially. Her parents think her condition could improve.

Doctors have said she would probably die within a week or two of the tube's removal.

Gauderer, director of surgery at Greenville Children's Hospital in South Carolina, said it would not be appropriate for him to give an opinion on the Schiavo case, but he thinks the government should not intervene in such cases.

''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 out through the belly. ''It's like threading pajama bottoms," Ponsky said.

Doctors soon began performing the procedure on adults, and it is now used in 99 percent of the cases in which feeding tubes are required, Ponsky said. Some nursing homes require feeding tubes be inserted that way because they are less likely to come loose than an IV or a tube through the nose.

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