Percutaneous endoscopic gastrostomy in head and neck cancer patients: indications, techniques, complications and results

Abstract

The aim of this study was to review our experience in percutaneous endoscopic gastrostomy (PEG) performed in patients with cancer of the upper aerodigestive tract. Descriptive retrospective study of 142 patients (115 males, 27 females), mean age 62.4 years (25-84 years), with head and neck or esophageal cancer, who underwent PEG tube insertion between January 2006 and December 2008. The studied parameters were indications, success rate, rate and type of complications, and their management. Percutaneous endoscopic gastrostomy was inserted before chemoradiation therapy in 80% and during or after cancer treatment in 20% of the patients. PEG placement was possible in 137 patients (96%). Major complications were observed in 9 (7%) and minor complications in 22 (17%) of the 137 patients. Seven of the 9 patients with a major complication needed revision surgery. The mortality directly related to the procedure was 0.7%. Percutaneous endoscopic gastrostomy tube insertion has a high success rate. In patients with upper aerodigestive tract cancer, PEG should be the first choice for enteral nutrition when sufficient oral intake is not possible. Although apparently easy, the procedure may occasionally lead to severe complications. Therefore, a strict technique and knowledge of clinical signs of possible complications are mandatory.

Factors affecting duration of gastrostomy tube retention in survivors following treatment for head and neck cancer

“…3 Several studies have examined the role of different clinical and patient factors that predict the need for gastrostomy tube placement. [4][5][6][7] However, there are no published data on factors affecting the duration of gastrostomy tube retention. Interviews of disease-free patients who retain their gastrostomy tube for over 12 months have identified several clinical, social and personal factors, 8 many of which are difficult to quantify.…”

Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

“…In addition, PEG feeding has a simple management which do not requires long feeding times for each meal, as needed with a thin diameter of the nasogastric tube. Even more important in this clinical setting of palliation, PEG as a minor interference with the patient's life, regarding comfort and esthetic aspects (12,13,16) . As expected all 17 proximal esophageal carcinomas were squamous cell carcinoma (6) .…”

Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

“…Many studies have examined the usefulness of PEG for aerodigestive cancer. A PEG tube was inserted in patients with oral intake difficulties for the purpose of nutrition support in all stages and locations, including patients who had undergone chemotherapy and chemoradiation therapy with curative intent [17][18][19][20][21][22] . Chemotherapy or chemoradiation therapy is frequently associated with mucositis, dysphagia, loss of taste and anorexia.…”

“…The major complications of the standard pull/push method, which requires an esophageal lumen sufficient to pass a standard endoscope [30] , include peristomal wound infections, presumably resulting from contamination of the gastrostomy catheter as it passes through the oral cavity [14,31] , and tumor implantation at the PEG site [28,32] which are specific for pull/push method in the aerodigestive cancer patients. In the literature on patients with cancer, the overall complication and mortality rates of the pull/push method in patients with head and neck cancer are 10.9%-42.0% and 0%-5%, respectively [15,17,18,[20][21][22][33][34][35][36] . An overall complication rate of 0%-11% and mortality rate of 0% have been reported with the introducer method [15,16,37,38] compared with the pull/push method in patients with aerodigestive cancer.…”