Percutaneous endoscopic gastrostomy in advanced head and neck cancer

Abstract

BACKGROUND: Percutaneous endoscopic gastrostomy performed as proposed by Gauderer et al. in 1980, has been used quite frequently in patients with head and neck tumors. Some authors believe that this so-called pull technique would be associated to the risk of a tumor implantation in the wound as well as high levels of peristomal wound infection. Although some alternative techniques provide better results, doubts about their technical applicability in daily practice still persists. AIM: To assess the feasibility, safety and morbidity of percutaneous endoscopic gastrostomy performed through a well-defined and standardized technique in patients with nonresectable or advanced head and neck cancer. METHODS: A consecutive series of patients who had either nonresectable or advanced tumors and were unable to be fed orally were submitted to an oncologic-hospital-based tertiary-referral endoscopy practice. Tubes were implanted through an introducer technique comprised of two main stages. The first consisted of the application of two stitches aiming to fixate the anterior gastric wall to the abdominal wall, and the second being the inserting of the gastrostomy tube. RESULTS: Between February 2003 and May 2004, 129 percutaneous endoscopic gastrostomies were performed. This study included 60 patients. They were all able to receive food on the same day. Operative morbidity was observed in six patients (10%) and one procedure-related mortality was also observed (1.6%). CONCLUSION: Percutaneous endoscopic gastrostomy is both feasible and safe, associated to low morbidity, and to acceptable mortality rates.

A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients

“…The complications related to PEG must be carefully evaluated, especially when a modification is proposed for a well-established technique. When applied in HNC patients, the introducer PEG technique with gastropexy presents minor complications, major complications, and mortality rates of 15 %, 2 %, and 1.5 %, respectively [1,2,9,10,37]. In the present series, only one major complication (3.3 %) and two minor ones (6.7 %) were noted.…”

Percutaneous gastrostomies in advanced cancer

“…2 As occurred in this study, some patients can be cured or at least have the disease controlled, allowing the gastrostomy removal. In this study, male patients predominate: 84% were male patients, like in other studies of gastrostomies in advanced cancer, as examples are 78% in head and neck patients 13 and 78% in patients with esophageal cancer. 14 In addition, in our previous study on gastrostomies in advanced cancer, 80% were male.…”

Modificação de dispositivo para gastrostomia endoscópica percutânea pela técnica de punção: utilização em pacientes com neoplasia maligna de cabeça e pescoço

“…A técnica de "punção" com gastropexia quando empregada em pacientes com CCP leva a complicações maiores e menores em 2,1% e 15%, respectivamente e mortalidade de 1,6% 15,16,44,45,67 .…”

“…Alguns grupos empregaram trocarte de cistostomias e sonda de pequeno calibre (Foley 14 -16 Fr), adaptadas para infusão de dietas 67 .…”

“…As sondas balonadas do tipo Foley têm sido empregadas há muitos anos para substituição das sondas de gastrostomia 111,179 ou como primeira opção nesse procedimento, principalmente em nosso meio 51,66,67 . Entretanto, são responsáveis por complicações, já que não possuem sistema de retentor externo eficiente que as fixe à parede abdominal além de apresentarem comprimento maior 29,111,179,180,181 45 que, aplicando a técnica de "punção" com gastropexia, encontraram tempo médio de procedimento de 14,2 min (entre 11,3 -…”