BACKGROUND: In esophageal or head and neck cancer patients, percutaneous endoscopic gastrostomy (PEG) by the pull method has higher complication rates than in noncancer patients. An introducer method is considered suitable for these patients, however, complications associated with deflation or rupture of the balloon-anchoring system are reported. AIM: To investigate the efficacy of a modified introducer method, called direct method, for aerodigestive cancer patients. MATERIALS AND METHODS: Between October 2007 and December 2010, direct-method PEG was performed in 160 patients with advanced-stage esophageal (59 patients) or head and neck (101 patients) cancer. Complications and postoperative course were retrospectively retrieved from charts. RESULTS: An ultrathin endoscopy was used in 109 patients (72.7%), and 23 patients received previous endoscopic dilatation (14%) due to the stricture caused by the tumor. The success rate of tube placement was 98.8% (158/160). Major complications related to tube insertion, such as panperitonitis, gastrointestinal hemorrhage, and postoperative pneumonia occurred in five patients (3.2%). One patient died for panperitonitis due to late-onset tube dislodgement. There were no cases of tube blockade and no metastases in the PEG site during the median follow-up period of 153 days. CONCLUSION: This was the first report of direct-method PEG in a number of esophageal or head and neck cancer patients. This method is optimal for its high success rate, acceptable safety profile, and little risk of stomal metastasis.
BACKGROUND: In esophageal or head and neck cancerpatients, percutaneous endoscopic gastrostomy (PEG) by the pull method has higher complication rates than in noncancer patients. An introducer method is considered suitable for these patients, however, complications associated with deflation or rupture of the balloon-anchoring system are reported. AIM: To investigate the efficacy of a modified introducer method, called direct method, for aerodigestive cancerpatients. MATERIALS AND METHODS: Between October 2007 and December 2010, direct-method PEG was performed in 160 patients with advanced-stage esophageal (59 patients) or head and neck (101 patients) cancer. Complications and postoperative course were retrospectively retrieved from charts. RESULTS: An ultrathin endoscopy was used in 109 patients (72.7%), and 23 patients received previous endoscopic dilatation (14%) due to the stricture caused by the tumor. The success rate of tube placement was 98.8% (158/160). Major complications related to tube insertion, such as panperitonitis, gastrointestinal hemorrhage, and postoperative pneumonia occurred in five patients (3.2%). One patient died for panperitonitis due to late-onset tube dislodgement. There were no cases of tube blockade and no metastases in the PEG site during the median follow-up period of 153 days. CONCLUSION: This was the first report of direct-method PEG in a number of esophageal or head and neck cancerpatients. This method is optimal for its high success rate, acceptable safety profile, and little risk of stomal metastasis.
Authors: Felipe A Retes; Fabio S Kawaguti; Marcelo S de Lima; Bruno da Costa Martins; Ricardo S Uemura; Gustavo A de Paulo; Caterina Mp Pennacchi; Carla Gusmon; Adriana Vs Ribeiro; Elisa R Baba; Sebastian N Geiger; Mauricio P Sorbello; Marco A Kulcsar; Ulysses Ribeiro; Fauze Maluf-Filho Journal: United European Gastroenterol J Date: 2016-07-21 Impact factor: 4.623