51
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McAllister P, MacIver C, Wales C, McMahon J, Devine J, McHattie G, Makubate B. Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates. Br J Oral Maxillofac Surg 2013; 51:714-8. [DOI: 10.1016/j.bjoms.2013.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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52
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Poulose BK, Kaiser J, Beck WC, Jackson P, Nealon WH, Sharp KW, Holzman MD. Disease-based mortality after percutaneous endoscopic gastrostomy: utility of the enterprise data warehouse. Surg Endosc 2013; 27:4119-23. [DOI: 10.1007/s00464-013-3077-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/17/2013] [Indexed: 11/29/2022]
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53
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Richards DM, Tanikella R, Arora G, Guha S, Dekovich AA. Percutaneous endoscopic gastrostomy in cancer patients: predictors of 30-day complications, 30-day mortality, and overall mortality. Dig Dis Sci 2013; 58:768-76. [PMID: 23007733 DOI: 10.1007/s10620-012-2397-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/28/2012] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cancer patients benefit from percutaneous endoscopic gastrostomy (PEG) in many ways including nutritional support and venting in cases of malignant obstruction. Lack of high-quality studies with adequate follow-up has led to limited information regarding risk stratification and predictors of morbidity and mortality. AIMS Elucidate predictors of complications and mortality with long-term follow-up in cancer patients undergoing PEG. METHOD Retrospective review of all patients undergoing PEG placement at MD Anderson Cancer Center from January 1, 2004 to December 31, 2006. Statistical analysis included descriptive statistics, Kaplan-Meier survival estimates, and Cox proportional hazards regression analyses. RESULTS A total of 218 subjects underwent PEG. Those with American Society of Anesthesiology (ASA) scores of 4, 4E, or 5E were at significant risk of a major complication in the first 30 days. Multivariate analysis revealed ASA scores ≥4, elevated WBC count, and advanced tumor stage to be independent predictors of mortality in the first 30 days and INR >1.5 and diversion/venting as an indication for PEG placement to be independent predictors of overall mortality. CONCLUSIONS Patients with high baseline illness severity are more likely to have complications and are at increased risk of mortality after PEG. Our study results suggest that particular attention be directed to ASA score, INR, WBC counts, transfusion requirements, presence of advanced malignancies, and the indication for PEG placement when determining risk of complications or death. Patients undergoing venting PEG are expected to have short post-PEG survival but improvement in quality of life likely justifies the risks associated with PEG placement.
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Affiliation(s)
- David M Richards
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, The University of Texas Medical School at Houston, Houston, TX, USA.
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Sadasivan A, Faizal B, Kumar M. Nasogastric and percutaneous endoscopic gastrostomy tube use in advanced head and neck cancer patients: a comparative study. J Pain Palliat Care Pharmacother 2013; 26:226-32. [PMID: 22973911 DOI: 10.3109/15360288.2012.702199] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To compare the efficacy of percutaneous endoscopic gastrostomy (PEG) and nasogastric (NGT) tube administration of enteral nutrition in head and neck cancer patients undergoing curative treatment, the authors conducted a prospective study to compare nutritional outcomes, complications, and patient satisfaction. PEG patients sustained significantly less reduction in nutritional parameters, measured at 6 weeks post insertion, as compared with NGT patients. There was also a statistically significant difference between the two groups in patient's quality of life scores and complications. Comparison could not be done at 6 months because all patients were converted to PEG feeding due to the earlier findings. The authors conclude that PEG is more efficacious than NGT as a channel for nutrition in advanced head and neck cancer patients over a short duration.
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Affiliation(s)
- Anjana Sadasivan
- Department of ENT, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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Sheth CH, Sharp S, Walters ER. Enteral feeding in head and neck cancer patients at a UK cancer centre. J Hum Nutr Diet 2013; 26:421-8. [DOI: 10.1111/jhn.12029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. H. Sheth
- Department of Nutrition & Dietetics; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - S. Sharp
- Department of Nutrition & Dietetics; University Hospital Southampton NHS Foundation Trust; Southampton UK
| | - E. R. Walters
- Department of Nutrition & Dietetics; University Hospital Southampton NHS Foundation Trust; Southampton UK
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Lohsiriwat V. Percutaneous endoscopic gastrostomy tube replacement: A simple procedure? World J Gastrointest Endosc 2013; 5:14-8. [PMID: 23330049 PMCID: PMC3547115 DOI: 10.4253/wjge.v5.i1.14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/04/2012] [Accepted: 12/01/2012] [Indexed: 02/05/2023] Open
Abstract
Replacement of gastrostomy tube in patients undergoing percutaneous endoscopic gastrostomy (PEG) is generally considered as a safe and simple procedure. However, it could be associated with serious complications, such as gastrocutaneous tract disruption and intraperitoneal tube placement, which may lead to chemical peritonitis and even death. When PEG tube needs a replacement (e.g., occlusion or breakage of the tube), clinicians must realize that the gastrocutaneous tract of PEG is more friable than that of surgical gastrostomy because there is no suture fixation between gastric wall and abdominal wall in PEG. In general, the tract of PEG begins to mature in 1-2 wk after placement and it is well formed in 4-6 wk. However, this process could take a longer period of time in some patients. Accordingly, this article describes three major principles of a safe PEG tube replacement: (1) good control of the replacement tube along the well-formed gastrocutaneous tract; (2) minimal insertion force during the replacement, and, most importantly; and (3) reliable methods for the confirmation of intragastric tube insertion. In addition, the management of patients with suspected intraperitoneal tube placement (e.g., patients having abdominal pain or signs of peritonitis immediately after PEG tube replacement or shortly after tube feeding was resumed) is discussed. If prompt investigation confirms the intraperitoneal tube placement, surgical intervention is usually required. This article also highlights the fact that each institute should have an optimal protocol for PEG tube replacement to prevent, or to minimize, such serious complications. Meanwhile, clinicians should be aware of these potential complications, particularly if there are any difficulties during the gastrostomy tube replacement.
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Affiliation(s)
- Varut Lohsiriwat
- Varut Lohsiriwat, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
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La Nauze RJ, Collins K, Lyon S, Bailey M, Kemp W, Nyulasi I, Roberts SK. Outcomes of percutaneous endoscopic gastrostomy versus radiologically inserted gastrostomy tube insertion at a tertiary hospital. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.clnme.2012.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Locher JL, Bonner JA, Carroll WR, Caudell JJ, Keith JN, Kilgore ML, Ritchie CS, Roth DL, Tajeu GS, Allison JJ. Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: a comprehensive review and call for evidence-based medicine. JPEN J Parenter Enteral Nutr 2011; 35:365-74. [PMID: 21527598 DOI: 10.1177/0148607110377097] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with head and neck cancers (HNCs) are at increased risk of experiencing malnutrition, which is associated with poor outcomes. Advances in the treatment of HNCs have resulted in improved outcomes that are associated with severe toxic oral side effects, placing patients at an even greater risk of malnutrition. Prophylactic placement of percutaneous endoscopic gastrostomy (PEG) tubes before treatment may be beneficial in patients with HNC, especially those undergoing more intense treatment regimens. PEG tube placement, however, is not without risks. METHODS A comprehensive review of the literature was conducted. RESULTS Systematic evidence assessing both the benefits and harm associated with prophylactic PEG tube placement in patients undergoing treatment for HNC is weak, and benefits and harm have not been established. CONCLUSIONS More research is necessary to inform physician behavior on whether prophylactic PEG tube placement is warranted in the treatment of HNC.
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Affiliation(s)
- Julie L Locher
- Department of Medicine, Division of Gerontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Assenat E, Thezenas S, Flori N, Pere-Charlier N, Garrel R, Serre A, Azria D, Senesse P. Prophylactic percutaneous endoscopic gastrostomy in patients with advanced head and neck tumors treated by combined chemoradiotherapy. J Pain Symptom Manage 2011; 42:548-56. [PMID: 21477980 DOI: 10.1016/j.jpainsymman.2011.01.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 01/07/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
Abstract
CONTEXT Few studies have evaluated outcomes of combined chemoradiotherapy for Stage III-IV head and neck squamous cell carcinoma in terms of the use of nutritional support by means of percutaneous endoscopic gastrostomy (PEG). OBJECTIVES To compare nutritional status and treatment interruption because of acute toxicity in patients with advanced head and neck tumors who were treated by combined chemoradiotherapy and received or did not receive prophylactic PEG tubes. METHODS This was a retrospective study that evaluated data obtained from a cancer center in Montpellier, France. A total of 139 consecutive patients treated for Stage III-IV head and neck squamous cell carcinoma from January 1, 1998 to June 30, 2003 were evaluated in terms of nutritional status before and after therapy, treatment interruption because of toxicity, and duration of hospitalization. RESULTS Seventy-eight of the 139 patients (58%) did not receive prophylactic PEG feeding, and 61 patients (44%) received PEG feeding. Pretreatment nutritional status was worse in the PEG group. Compared with the initial nutritional status, nutritional status at the end of treatment was unchanged in the PEG group and much worse in the group that did not receive the PEG (P<0.05). Cumulative incidence of treatment interruption because of toxicity was significantly lower in the PEG group than in the no-PEG group (100 and 236 days of interruption, respectively, P=0.03) and hospitalization was significantly shorter (P=0.003). CONCLUSION Prophylactic PEG sustains nutritional status and reduces the cumulative incidence of treatment interruption caused by toxicity and duration of hospitalization. A randomized study is warranted to validate these results.
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Affiliation(s)
- Eric Assenat
- Department of Gastro-Nutrition, Val d'Aurelle Cancer Institute, Montpellier, France
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60
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Burkitt P, Carter L, Smith A, Kanatas A. Outcomes of percutaneous endoscopic gastrostomy and radiologically inserted gastrostomy in patients with head and neck cancer: a systematic review. Br J Oral Maxillofac Surg 2011; 49:516-20. [DOI: 10.1016/j.bjoms.2010.09.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 09/02/2010] [Indexed: 11/25/2022]
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Multidisciplinary Practical Guidelines for Gastrointestinal Access for Enteral Nutrition and Decompression From the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, With Endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). J Vasc Interv Radiol 2011; 22:1089-106. [DOI: 10.1016/j.jvir.2011.04.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 04/08/2011] [Accepted: 04/08/2011] [Indexed: 12/16/2022] Open
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Itkin M, DeLegge MH, Fang JC, McClave SA, Kundu S, d'Othee BJ, Martinez-Salazar GM, Sacks D, Swan TL, Towbin RB, Walker TG, Wojak JC, Zuckerman DA, Cardella JF. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Gastroenterology 2011; 141:742-65. [PMID: 21820533 DOI: 10.1053/j.gastro.2011.06.001] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 04/08/2011] [Indexed: 02/06/2023]
Affiliation(s)
- Maxim Itkin
- Department of Radiology, Division of Interventional Radiology, University of Pennsylvania Medical Center, Pennsylvania Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.
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63
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Rolston KVI, Mihu C, Tarrand JJ. Current microbiology of percutaneous endoscopic gastrostomy tube (PEG tube) insertion site infections in patients with cancer. Support Care Cancer 2011; 19:1267-71. [PMID: 21553315 DOI: 10.1007/s00520-011-1177-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 04/25/2011] [Indexed: 01/16/2023]
Abstract
PURPOSE Percutaneous endoscopic gastrostomy (PEG) is frequently used to provide enteral access in cancer patients who are unable to swallow. Infection is an important complication in this setting. Current microbiological data are needed to guide infection prevention and treatment strategies. METHODS The microbiological records of our institution (a 550-bed comprehensive cancer center) were retrospectively reviewed over an 8-month study period in order to identify patients who developed PEG tube insertion site infections, and review their microbiological details and susceptibility/resistance data. RESULTS Fifty-eight episodes of PEG tube insertion site infections were identified. Of these, 31 (53%) were monomicrobial, and the rest were polymicrobial. The most common organisms isolated were Candida species, Staphylococcus aureus, and Pseudomonas aeruginosa. All infections were local (cellulitis, complicated skin, and skin structure infections including abdominal wall abscess) with no cases of concomitant bacteremia being documented. Most of the organisms isolated were susceptible to commonly used antimicrobial agents, although some quinolone-resistant and some multidrug-resistant organisms were isolated. CONCLUSIONS This retrospective study provides descriptive data regarding PEG tube insertion site infections. These data have helped us update institutional guidelines for infection prevention and treatment as part of our focus on antimicrobial stewardship.
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Affiliation(s)
- Kenneth V I Rolston
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas, M. D. Anderson Cancer Center, Houston, TX, USA.
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64
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Faria GR, Taveira-Gomes A. Open gastrostomy by mini-laparotomy: a comparative study. Int J Surg 2011; 9:263-6. [PMID: 21199694 DOI: 10.1016/j.ijsu.2010.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Revised: 10/25/2010] [Accepted: 11/15/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Gastrostomy tube feeding is the best option for long lasting nutritional support in patients with dysphagia caused by obstructive tumours of the mouth, pharynx, larynx and ooesophagus or neuromuscular diseases. However, these severely compromised patients often present severe respiratory risks, precluding the use of general anesthesia, sedation or even endoscopy. A simplified open gastrostomy (SOG) under local anesthesia has been in practice in our institution, especially for patients with severe neuromuscular diseases and continuous non-invasive ventilatory support. In this study, we try to compare the surgical outcomes of this technique, with the classical Stamm gastrostomy (SG). MATERIAL AND METHODS This simplified technique uses a minimal vertical midline incision (3 cm), just below the xyphoid process, under local anesthesia. The gastrostomy tube is passed by a left lateral stab wound, inserted in a double purse-string in the gastric wall and pulled to the anterior abdominal wall. No sutures between the stomach and the peritoneum are placed. We retrospectively analyzed the clinical records of 63 consecutive gastrostomies performed upon a 3-year period, 23 of which were by SOG. RESULTS The SG was performed mainly in oncological patients, and SOG in patients with neuromuscular diseases (p < 0.001). In the SOG group, 95,4% (n = 22) of the patients were ASA IV, compared with 74,4% (n = 29) in SG (p = 0,03). The mean operative time was shorter in the simplified technique (37 vs 60 min; p = 0,01). All the surgeries in the SOG group were performed exclusively with local anesthesia and in the Stamm procedure, 47,5% required invasive ventilatory support (p < 0.001). There were no significant differences regarding in-hospital morbi-mortality (p = 0,18). The patients were able to receive adequate nutritional support, and the overall satisfaction of the patients and family/caregivers is very good. CONCLUSION The simplified mini-laparotomy gastrostomy is a safe and effective alternative to other approaches. The association of local anesthesia with a minimal surgical offense and a short operative time render its effectiveness, even in high-risk patients.
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Affiliation(s)
- Gil R Faria
- Department of Surgery, Faculty of Medicine, University of Porto, Hospital S. João, General Surgery Department, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
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Sarap AN, Sarap MD, Childers J. Small bowel necrosis in association with jejunal tube feeding. JAAPA 2010; 23:1142-5. [PMID: 21086887 DOI: 10.1007/s00464-009-0382-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 11/20/2008] [Accepted: 12/16/2008] [Indexed: 01/12/2023]
Abstract
Early recognition and appropriate treatment of bowel ischemia is imperative to reduce morbidity and mortality in any situation, including in conjunction with enteral tube feeding. GI intolerance can manifest as increased nasogastric tube output, unexplained abdominal pain/distension, and pneumatosis intestinalis in critically ill patients who are on tube feedings and may be experiencing periods of splanchnic hypotension. Recommendations are to immediately cease tube feedings when these signs and symptoms are recognized, and total parenteral nutrition should be considered. Surgical exploration during the early stages should be considered to prevent the usual and fatal catastrophic cascade of widespread bowl infarction.
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66
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Paleri V, Patterson J. Use of gastrostomy in head and neck cancer: a systematic review to identify areas for future research. Clin Otolaryngol 2010; 35:177-89. [PMID: 20636736 DOI: 10.1111/j.1749-4486.2010.02128.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To perform a systematic review of studies, which investigate the role of gastrostomy tube feeding in head and neck squamous cell cancer. DESIGN A systematic review of the English literature, identifying areas of clinical equipoise and recommendations for future studies. MAIN OUTCOME MEASURES Varying practices in G-tube use in HNSCC, the benefits and disadvantages of G-tubes, the effect of G-tube placement on multidimensional outcomes in patients with head and neck cancer, including quality of life and health economics and to draw themes that may lend themselves to future research. RESULTS The search identified 216 articles of which 59 were considered relevant. During treatment, a significant number of patients need enteral nutritional supplementation through nasogastric or G-tubes. Gastrostomy tubes have a good safety profile. Most clinicians agree that the use should be restricted to advanced tumours. Studies on prophylactic insertion of G-tubes do not show a consistent advantage to the nutritional status compared with NG tubes. At 1 year, G-tube retention rates vary between 10% and 30%. The presence of a feeding tube has a negative impact on quality of life. Placing G-tubes may have an adverse effect on swallowing after chemoradiation. CONCLUSIONS There is a lack of consensus among clinicians about indications for placing G-tubes. There is sufficient equipoise in this area for further investigation of the effect of varying feeding practices on functional outcomes, quality of life and health economics.
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Affiliation(s)
- V Paleri
- The Newcastle upon Tyne Foundation Hospitals NHS Trust, Newcastle Upon Tyne, UK.
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Abstract
OBJECTIVES We sought to conduct an assessment of the practice of gastrostomy (G) tube placement across an entire city, which would reflect usual clinical care as compared with referral center practice. METHODS We reviewed and retrospectively extracted data from patient records for all percutaneous endoscopic G (PEG) and radiological percutaneous G (RPG) tube placements at six Winnipeg hospitals between 1 April 2005 and 31 March 2007. RESULTS A total of 418 patients had G tubes (376 PEG, 42 RPG) inserted during the study period. The most common indications were cerebrovascular accidents (25%), head and neck cancer (23%), and head trauma (10%). The position of the external bolster was not documented in 38% of patients. The median time to the first complication was 10 days, initiation of feeding was 48 hours, and tube removal was 40 days. Complications developed in 102 (24%) patients. Patients with RPG tubes had more infections and were less likely to receive prophylactic antibiotics (P<0.001). In multivariate analysis, complications were more likely to occur in patients with RPG tubes and after insertions by lowest procedure volume physicians. Overall mortality was 12% within 30 days of G-tube placement. Death of one patient was directly related to peritonitis after G-tube insertion. CONCLUSIONS In usual clinical practice, there is an underuse of prophylactic antibiotics and a delay in the institution of nutritional support after G-tube placement. A small but significant proportion of patients may develop major complications, with associated risk of mortality. The higher complication rate after procedures performed by lowest volume physicians needs further evaluation.
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Survival analysis after gastrostomy: a single-centre, observational study comparing radiological and endoscopic insertion. Eur J Gastroenterol Hepatol 2010; 22:591-6. [PMID: 19966570 DOI: 10.1097/meg.0b013e328332d2dd] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Percutaneous endoscopic gastrostomy (PEG) using the pull through technique is the most widely used insertion method. An alternative is a per-oral image-guided gastrostomy (PIG), which may be advantageous in high-risk patients. As there are no large studies comparing PEG against PIG, we wished to analyse mortality after endoscopic or radiological gastrostomy insertion. METHODS Patients referred for a gastrostomy are prospectively included in a database along with demographic, biochemical and outcome data. Analysis of gastrostomy insertions from February 2004 to 2007 was performed with reference to method of insertion and 30-day outcome. Patients were subgrouped into cognitive impairment, dysphagic stroke, oropharygeal cancer, neurological cancer and other. RESULTS One hundred and seventy PIGs and 233 PEGs were inserted (mean age 62 years, 268 males). There were no differences in age between the PIG and the PEG group. The PIG 30-day mortality was 26 of 170 (15.3%) and the PEG 30-day mortality was 25 of 233 (10.7%) (P=0.17). One-year mortality was 92 of 170 (54.1%) for PIG and 131 of 233 (56.7%) for PEG (P=0.60). Subgroup analysis revealed higher 30-day mortality in patients with nasopharyngeal cancer undergoing PIG; 14 of 106 (13.2%) versus one of 69 (1.4%) (P=0.005). However, PIG patients were older than PEG patients (mean age 64 vs. 59.7 years, P=0.019) and had more comorbidities (21.1% in the PEG group and 37.7% in the PIG group). CONCLUSION Overall PIG and PEG seem to have similar 30-day and 1-year mortality rates. Our data suggest that clinicians may opt for either approach depending on technical considerations and local availability.
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Percutaneous laparoscopic assisted gastrostomy (PLAG)—a new technique for cases of pharyngoesophageal obstruction. Langenbecks Arch Surg 2010; 395:1107-13. [DOI: 10.1007/s00423-010-0612-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 02/08/2010] [Indexed: 12/13/2022]
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McLaughlin BT, Gokhale AS, Shuai Y, Diacopoulos J, Carrau R, Heron DE, Smith RP, Gibson MK, Ferris RL, Grandis JR, Johnson JT, Argiris A. Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: the University of Pittsburgh experience. Laryngoscope 2010; 120:71-5. [PMID: 19877245 DOI: 10.1002/lary.20697] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G-tube). METHODS We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G-tubes were placed as needed. The timing and duration of G-tube placement and treatment-related complications and risk factors for long-term G-tube use were analyzed. RESULTS A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy-nine percent of patients received platinum-based therapy during CRT. Severe mucositis occurred in 40% of patients. Forty percent of patients required G-tube placement (15 prior to CRT and 21 during CRT). Median duration of G-tube use was 5.8 months. Two patients who had a G-tube placed during CRT developed a G-tube-related complication. At 6 and 12 months, 15 (18%) and four (6%) patients who were disease free were using G-tubes, respectively. Patients with G-tubes placed prior to CRT or advanced T stage had longer G-tube dependence. CONCLUSIONS With aggressive supportive care it is feasible to avoid G-tubes in the majority of patients undergoing CRT for head and neck cancer. G-tube placement prior to CRT due to pre-existing dysphagia and advanced T stage are associated with prolonged G-tube dependence.
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Affiliation(s)
- Brian T McLaughlin
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, USA
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Barber AJ, Lowe D, Lal S, Rogers SN. Survey of gastrostomy insertion technique used in oncology patients in UK Oral and Maxillofacial units. J Craniomaxillofac Surg 2010; 38:60-3. [DOI: 10.1016/j.jcms.2009.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 07/28/2009] [Accepted: 09/11/2009] [Indexed: 12/27/2022] Open
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Pain in the RIG? Proc Nutr Soc 2010. [DOI: 10.1017/s0029665109993752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Corry J, Poon W, McPhee N, Milner AD, Cruickshank D, Porceddu SV, Rischin D, Peters LJ. Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation. Head Neck 2009; 31:867-76. [PMID: 19296528 DOI: 10.1002/hed.21044] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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 = .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.
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Affiliation(s)
- June Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Australia.
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Grant DG, Bradley PT, Pothier DD, Bailey D, Caldera S, Baldwin DL, Birchall MA. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009; 34:103-12. [PMID: 19413607 DOI: 10.1111/j.1749-4486.2009.01889.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. DESIGN A prospective cohort study and qualitative systematic review. SETTING Multi-cancer networks in the South West of England, Hampshire and the Isle of White. PARTICIPANTS One hundred and seventy-two patients with head and neck cancer undergoing gastrostomy tube insertion between 2004 and 2005. Percutaneous endoscopic gastrostomy (PEG) was performed in 121 patients. Fifty-one patients had radiologically inserted gastrostomy (RIG). Twenty-seven studies reporting outcomes following 2353 gastrostomy procedures for head and neck cancer. MAIN OUTCOME MEASURES Post-procedure mortality, major and minor complications. RESULTS In the present series, mortality rates were 1.0% (1/121) for PEG and 3.9% (2/51) for RIG. Overall major complication rates following PEG and RIG were 3.3% (4/121) and 15.6% (9/51) respectively. In our systematic review and meta-analysis of 2379 head and neck cancer patients, we observed fatality rates of 2.2% (95% CI 0.014-0.034) following PEG and 1.8% (95% CI 0.010-0.032) following RIG. Furthermore, major complication rates following PEG were 7.4% (95% CI 5.9-9.3%) and 8.9% (95% CI 7.0-11.2%) after RIG. CONCLUSIONS Procedure related mortality rates following gastrostomy in head and neck cancer patients are higher than those in mixed patient populations. Major complication rates following RIG in head and neck cancer patients are greater than those following PEG. Major complications following PEG in patients with head and neck cancer appear no worse than in mixed pathology groups. We have identified that RIG is associated with increased morbidity and mortality in patients who are ineligible for PEG. The serious nature of the complications associated with gastrostomy particularly in patients with head and neck cancer requires careful consideration by the referring physician.
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Affiliation(s)
- D G Grant
- Department of Otolaryngology, Head and Neck Surgery, Southmead Hospital, Bristol, UK.
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75
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La nutrition dans la prise en charge des cancers ORL. ONCOLOGIE 2009. [DOI: 10.1007/s10269-008-1028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Corry J, Poon W, McPhee N, Milner AD, Cruickshank D, Porceddu SV, Rischin D, Peters LJ. Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation. J Med Imaging Radiat Oncol 2009; 52:503-10. [PMID: 19032398 DOI: 10.1111/j.1440-1673.2008.02003.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Oakley RJ, Donnelly R, Freeman L, Wong T, McCarthy M, Calman F, O'Connell M, Jeannon JP, Simo R. An audit of percutaneous endoscopic gastrostomy insertion in patients undergoing treatment for head and neck cancer: reducing the incidence of peri-operative airway events by the introduction of a tumour assessment protocol. Ann R Coll Surg Engl 2009; 91:249-54. [PMID: 19220948 DOI: 10.1308/003588409x391857] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The presence of a malignancy of the upper aerodigestive tract introduces the potential for iatrogenic complications additional to those usually associated with percutaneous endoscopic gastrostomy. Specifically, seeding of tumour from the upper aerodigestive tract creating abdominal wall metastases, and airway obstruction due to tumour directly occluding the airway when a patient is sedated for percutaneous endoscopic gastrostomy. PATIENTS AND METHODS We report an audit of our experience of gastrostomy placement for patients under going treatment for head and neck cancer in our institution from September 2003 to October 2006. RESULTS Of 33 patients who had percutaneous endoscopic gastrostomy insertion under sedation in the first cycle of the audit, two (6%) experienced major airway complications resulting in one fatality. A tumour assessment protocol was introduced. In the second cycle, 96 patients had percutaneous endoscopic gastrostomies, of whom 16 (13%) underwent gastrostomy insertion under general anaesthetic and five (4.5%) under radiological guidance. No patients had airway complications or abdominal wall metastases. CONCLUSIONS A formal tumour assessment protocol eliminated airway obstruction as a complication of percutaneous endoscopic gastrostomy insertion and may reduce the potential for abdominal wall metastases at the gastrostomy site when using the pull technique.
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Affiliation(s)
- Richard J Oakley
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Complications arising from percutaneous endoscopic- and radiologically-inserted gastrostomies in a cohort of patients with head and neck cancer. Proc Nutr Soc 2009. [DOI: 10.1017/s0029665109002079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cantwell CP, Perumpillichira JJ, Maher MM, Hahn PF, Arellano R, Gervais DA, Mueller PR. Antibiotic Prophylaxis for Percutaneous Radiologic Gastrostomy and Gastrojejunostomy Insertion in Outpatients with Head and Neck Cancer. J Vasc Interv Radiol 2008; 19:571-5. [DOI: 10.1016/j.jvir.2007.11.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Revised: 11/13/2007] [Accepted: 11/14/2007] [Indexed: 01/25/2023] Open
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Avery C, Shenoy S, Shetty S, Siegmund C, Mazhar I, Taub N. The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique. Int J Oral Maxillofac Surg 2008; 37:140-8. [DOI: 10.1016/j.ijom.2007.08.465] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 06/18/2007] [Accepted: 08/31/2007] [Indexed: 10/22/2022]
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