Habib Toni, Mulrooney Niamh Siobhán, Grabie Yisroel, Maruf Mohammad, Kasapira Sophia
Staten Island University Hospital, Staten Island, New York.
Touro College of Osteopathic Medicine, New York, New York.
HCA Healthc J Med. 2025 Feb 1;6(1):99-104. doi: 10.36518/2689-0216.1836. eCollection 2025.
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative condition that is not easily diagnosed and has no curative treatments available, essentially requiring palliative measures, including tube feeding. Nonetheless, data shows that the endoscope used for percutaneous endoscopic gastrostomy (PEG) tube insertion can be a vector for CJD transmission.
We discuss the case of an elderly patient diagnosed with CJD, requiring tube feeding. Multiple specialists were consulted, and they were unable to reach an agreement on the best approach. Eventually, the hospital ethics committee intervened, and the family agreed to comfort measures only. This case report sheds light on the ethical challenges surrounding the use of endoscopically assisted PEG tube placement for patients with confirmed or suspected CJD.
Ethical consideration for patients with dementia, especially with CJD, includes evaluating harm and benefit, considering legal and societal responsibilities, respecting autonomy, and managing transmission risks. Based on our findings, we encourage interdisciplinary collaboration when navigating complex medical decision-making for patients with human prion diseases and advanced dementia.
克雅氏病（CJD）是一种快速进展的神经退行性疾病，不易诊断且没有可用的治愈性治疗方法，基本上需要采取姑息措施，包括鼻饲。尽管如此，数据表明用于经皮内镜下胃造口术（PEG）置管的内镜可能是克雅氏病传播的载体。
我们讨论了一例被诊断为克雅氏病且需要鼻饲的老年患者的病例。咨询了多位专家，但他们未能就最佳方法达成一致。最终，医院伦理委员会进行了干预，家属同意仅采取舒适护理措施。本病例报告揭示了为确诊或疑似克雅氏病患者进行内镜辅助PEG置管时所面临的伦理挑战。
对痴呆患者，尤其是克雅氏病患者的伦理考量包括评估危害和益处、考虑法律和社会责任、尊重自主权以及管理传播风险。基于我们的研究结果，我们鼓励在为患有人类朊病毒病和晚期痴呆的患者进行复杂医疗决策时开展跨学科合作。
