Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer

Retes, Felipe Alves; Kawaguti, Fábio S.; Lima, Marcelo Simas de; Martins, Bruno Costa; Uemura, Ricardo S.; Paulo, Gustavo Andrade de; Pennacchi, Caterina; Gusmon, Carla; Ribeiro, Adriana Vs; Baba, Elisa Ryoka; Geiger, Sebastian; Sorbello, Mauricio; Kulcsar, Marco Aurélio Vamondes; Ribeiro, Ulysses; Maluf‐Filho, Fauze

doi:10.1177/2050640616662160

Cited by 18 publications

(21 citation statements)

References 35 publications

(112 reference statements)

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“…PEG placement is done by puncturing the abdominal wall; therefore, bleeding is a logical consequence and may be underreported by physicians. Periprocedural minor bleeding is reported significant more with the push‐type, which is supported by two other studies 20,21 . Minor bleeding is defined as no intervention was required, whereas major bleeding surgical or endoscopic intervention was needed.…”

Section: Discussionsupporting

confidence: 55%

Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study

et al. 2021

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Background and Aims Percutaneous endoscopic gastrostomy (PEG) is indicated for prolonged enteral nutrition. This study aimed to analyze the outcome and to identify potential risk factors for complications in PEG procedures. Methods A single‐center retrospective analysis of the performed PEG procedures during the period January 2010 till January 2020. Results A PEG placement procedure was performed in 854 patients (64.1% male) and was successful in 833 (97.5%). In total, 513 push (61.6%) and 320 pull (38.6%) PEGs were placed. The mean age was 60.7 years, and the median follow‐up was 267 days. The push PEG was associated with peri‐procedural bleeding (P = 0.002) and tube dislodgements (P < 0.001), while the pull PEG was significantly associated with buried bumpers (P < 0.001), infected placement sites (P = 0.019), and granulation tissue formation (P = 0.044). The PEG‐related mortality rate was 0.2%, but the overall 30‐day mortality was 4.0%. Conclusion The current study showed that the push and pull PEG placements are both safe and feasible procedures, with a low PEG‐related mortality. Buried bumpers, infected placement sites, and granulation tissue formation are more often seen in the pull PEG, while the push PEG is associated with periprocedural bleeding and tube dislodgements. These complications should be taken into account and there is a need for a prospective trial to identify superiority between the PEG methods.

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Section: Discussionsupporting

confidence: 55%

Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study

et al. 2021

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“…Evidências sugerem que o método de escolha para realização de gastrostomia em paciente com CCP deve buscar evitar o contato entre a sonda e o tecido tumoral, uma vez que a passagem da sonda pode translocar células tumorais e implantá-las na mucosa gástrica. ( 2 ) A técnica de escolha para realização da GEP deve ser feita individualmente, considerando caso a caso, ( 7 ) no entanto a técnica de tração é preferida quando não há obstrução do trato gastrintestinal superior, dada a menor taxa de eventos adversos a curto prazo. ( 6 ) Outras opções podem ser consideradas, como a técnica percutânea com fluoroscópio, uma vez que não necessita de sonda e nem da passagem desta pelo sítio tumoral; ( 2 ) a realização de laparoscopia ou procedimento aberto para posicionamento da sonda (com os devidos cuidados para manter o sítio cirúrgico e o equipamento separados, buscando evitar contaminação da mucosa gástrica, que possa posteriormente gerar novas metástases); ou até mesmo considerar a quimioterapia ou quimioradioterapia antes da GEP em paciente com intenção de cura.…”

Section: Discussionunclassified

“…Evidence suggests that the method of choice for gastrostomy in patient with HNC should seek to avoid contact between the probe and the tumor tissue, since the passage of the probe can translocate tumor cells and implant them in the gastric mucosa. (2) The technique to perform EPG should be individually chosen, considering case-by-case; (7) however, the traction technique is preferred when there is no obstruction in the upper gastrointestinal tract, given the lower rate of short-term adverse events. (6) Other options may be considered, such as the percutaneous technique with fluoroscope, since there is no need for a probe or its passage through the tumor site; (2) performance of laparoscopy or open procedure (with the due care to maintain separate the surgical site and the equipment, in order to avoid contamination of the gastric mucosa, which might posteriorly generate new metastases); or even to consider chemotherapy or chemotherapy plus radiation therapy before EPG in an patient with the purpose of curing.…”

Section: ❚ Introductionmentioning

confidence: 99%

Squamous cell carcinoma implantation in gastrostomy orifice. Case report

Querichelli¹,

Faria²,

Martinez³

et al. 2020

Einstein (São Paulo)

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Percutaneous endoscopic gastrostomy is used to provide enteral nutritional support for patients with obstructive oropharyngeal or esophageal neoplasms. The placement of the catheter is considered safe, with few complications. Despite this, a specific complication that is considered rare, has been increasingly described in the literature, i.e., metastasis of head and neck cancer in the gastrostomy stoma. In this report, we described a case of metastasis of squamous cell carcinoma of the larynx in the gastrostomy site, and discussed the possible etiologies and alternatives, seeking to reduce the incidence of this complication.

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“…Thus, the use of a direct gastric puncture technique for percutaneous feeding tube placement in patients with proximal GI cancer has been recommended by several authors, especially in patients receiving radical therapy with curative intent [20,25]. Comparative studies have shown similar complication rates, except for a more common occurrence of delayed tube disfunction and minor bleeding episodes with the introducer approach [30,31].…”

Section: Nasal Tubesmentioning

confidence: 99%

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

Nunes

Fonseca

Barata

et al. 2019

GE Port J Gastroenterol

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Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

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Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer

Abstract: The push and introducer PEG techniques seem to be both safe and effective but present different complication profiles. The choice of PEG technique in patients with HNC should be made individually.

Cited by 18 publications

References 35 publications

Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study

Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study

Squamous cell carcinoma implantation in gastrostomy orifice. Case report

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

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