Predictors of the need for prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients treated with concurrent chemoradiotherapy

Reevaluation of the Merits and Demerits of Prophylactic Gastrostomy in Patients with Head and Neck Cancer Undergoing Concurrent Chemoradiotherapy

“…The expected merits of suppressing weight loss are reduced side effects of CCRT and the completion of chemotherapy; however, the doses of anticancer agents and rates of treatment completion were described in four articles, which constitute only less than half of the articles analyzed, partly because chemotherapy regimens used in these studies were not uniform. 9 11 13 16 In those articles, the completion rate in patients who did not undergo prophylactic gastrostomy or underwent reactive PEG was 66.7 to 81.7%, which was slightly lower than the 80.1 to 96% found in patients who underwent pPEG; one cannot rule out the possibility that the effectiveness of nutrition therapy was not evaluated accurately because the treatment intensity was too low.…”

“…Complications associated with gastrostomy have been reported to occur in 5 to 10% of cases and include mild ones, such as infection and pain at the gastrostomy site. 10 12 16 Among the cases included in this study, blood oozing on the body surface after gastrostomy occurred in six (16.7%) patients; this bleeding was arrested by compression with a Y-gauze in five patients and by additional suturing around the gastrostomy site in the remaining one patient. Other complications were pain around the gastrostomy site due to infection in three (5.6%) patients, one of which was treated using systemic antibiotics, and early gastrostomy tube replacement for tube incompatibility in one (1.9%) patient.…”

“…Decreased swallowing function, which was reflected by the use of gastrostomy tube feeding or the gastrostomy maintained after the end of treatment, was noted in approximately 0 to 24% of patients 6 to 12 months after the end of treatment. 7 8 9 10 11 12 13 14 16 Many articles reporting the incidence rates of approximately 20% appear to constitute a basis for seeing gastrostomy dependence as a problem after pPEG. However, reports have documented that decreased swallowing function occurred in 11 to 65% of cases in the reactive PEG group consisting of patients who commenced treatment without undergoing gastrostomy and then underwent gastrostomy during the treatment, highlighting the fact that withdrawal from gastrostomy tube feeding can be difficult in some cases.…”

“…We summarized 10 studies that were reported in or after 2010 and compared pPEG and other feeding means in !80 patients in ►Table 3. [7][8][9][10][11][12][13][14][15][16] Most studies (including ours) were retrospective in nature. As for the selection of feeding methods, pPEG was chosen as a general rule in a relatively small number of studies (including ours), and the choices were made subjectively by physicians when they decided whether to perform pPEG in the majority of studies.…”

Evaluation of Oropharyngeal Dysphagia in Older Patients for Risk Stratification of Pneumonia

“…The two commonly used methods of enteral tube feeding are nasogastric tube (NGT) and percutaneous endoscopic gastrostomy (PEG) (8). Aspiration pneumonia is the most common cause of death in these patients with enteral tube feeding (9,10), with estimated incidence rates of 12%-87% for NGT (11)(12)(13)(14)(15) and 9%-52% for PEG (12)(13)(14)(15). At present, NGT is recommended for temporary enteral nutrition lasting less than 4 weeks, whereas PEG is recommended for cases longer than 4 weeks (16).…”