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

Abstract

Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group.

How should this patient with repeated aspiration pneumonia be managed and treated?—a proposal of the Percutaneous ENdoscopIc Gastrostomy and Tracheostomy (PENlIGhT) procedure

“…A total of 11 RCTs were included in the systematic review ( Table 2) (35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45). Four trials explicitly stated they included patients with CVA complicated by dysphagia (36,38,41,42).…”

Comparison of Treatment Compliance and Nutritional Outcomes among Patients with Nasopharyngeal Carcinoma with and without Percutaneous Endoscopic Gastrostomy during Chemoradiation

“…Although a randomized study that closed early because of poor accrual showed PPEG is not different from a nasogastric tube in maintaining weight during radiation treatment (Corry et al, 2008). Then PPEG is occasionally a needless procedure.…”

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“…Zum Vergleich zwischen nasogastralen und perkutanen Sonden liegen eine RCT [295], 2 retrospektive Vergleiche [292,296] sowie 2 Cochrane-Analysen [272,297] und 2 weitere systematische Reviews vor [298,299]. Diese Publikationen berichten für beide Methoden über vergleichbare Wirksamkeit auf das Körperge-wicht [295,296] und vergleichbar geringe Komplikationsraten [295,297,298] sowie keine Unterschiede im Überleben [299]; allerdings verrutschen nasogastrale Sonden sehr viel leichter (relatives Risiko PEG/NG = 0,17) [299] und es kommt häufiger zum Interventionsversagen (PEG 12 % vs. NG 40 %) [297]. Auffällig ist dagegen, dass eine PEG-Ernährung deutlich länger durchgeführt wurde als eine nasogastrale Ernährung (Liegedauer 28 vs. 8 [292] bzw.…”