Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation

Abstract

Background. Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGTs) for nutritional support of patients with head and neck cancer undergoing curative (chemo) radiotherapy without any good scientific basis.Methods. A prospective study was conducted to compare PEG tubes and NGTs in terms of nutritional outcomes, complications, patient satisfaction, and cost.Results. There were 32 PEG and 73 NGT patients. PEG patients sustained significantly less weight loss at 6 weeks post-treatment (median 0.8 kg gain vs 3.7 kg loss, p < .001), but had a high insertion site infection rate (41%), longer median duration of use (146 vs 57 days, p < .001), and more grade 3 dysphagia in disease-free survivors at 6 months (25% vs 8%, p ¼ .07). Patient self-assessed general physical condition and overall quality of life scores were similar in both groups. Overall costs were significantly higher for PEG patients.Conclusion. PEG tube use should be selective, not routine, in this patient population.

Long-term Swallow Function after Chemoradiotherapy for Oropharyngeal Cancer: The Influence of a Prophylactic Gastrostomy or Reactive Nasogastric Tube

“…Prophylactic feeding tube placement compared with a reactive approach has been reported in several studies to reduce the extent of treatment related weight loss and hospital admissions 4,9,10 , and to lead to improved short term quality of life 12,13 . However, long term swallowing function is a major late toxicity associated with treatment, and should be a major factor in selecting the optimal strategy to support nutrition.…”

“…This remains a contentious area, and both approaches to enteral feeding have advantages and drawbacks. Several studies have suggested that the use of prophylactic gastrostomy placement is associated with a reduction in weight loss during treatment, a lower rate of hospitalisation 4,[9][10][11] , and improved quality of life during and soon after treatment 12,13 . Disadvantages of prophylactic gastrostomy placement prior to treatment include the possibility that the tube will not be required, a small risk of tube-related morbidity 14 , and the uncertain influence upon long term enteral feeding dependency rates 6,[9][10][11]15 .…”

“…For example, an analysis of 3 RTOG studies found 13% of patients were gastrostomy-dependent 2 years post treatment 16 . Several studies have reported a significantly increased duration of enteral feeding with prophylactic gastrostomies compared with a reactive enteral feeding approach 9,10,15,18 . This has led to concern that the use of prophylactic gastrostomy tubes may lead to poorer long term swallow function 6,11,19 .…”

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

“…In addition, ASCO guidelines [137] • Regarding the enteral nutrition, there were significantly more infections in the PEG group (66%) compared to the NGT group (30%) p = 0.001 in the prospective study of Corry et al [124], but the difference of pneumonia between the two groups (PEG = 31.3% vs. NGT = 30%) was statistically insignificant. In fact, the majority of infections in the PEG group were at the PEG site (31%: 10/32).…”

“…The main infection sources in HNCPs are the respiratory tract, the oral cavity, and medical devices such as central venous catheters (CVCs) [122], especially total implanted access ports [123], gastrostomy [124], and tracheostomy [47].…”