Sa1668 Results of Two Different Techniques of Percutaneous Endoscopic Gastrostomy in Patients With Head and Neck Cancer - Experience of a Tertiary Referral Academic Center

Abstract

Results of Two Different Techniques of Percutaneous Endoscopic Gastrostomy in Patients With Head and Neck Cancer Experience of a Tertiary Referral Academic Center Felipe A. Retes, Fauze Maluf-Filho, Fabio S. Kawaguti, Carla Z. Neves, Bruno C. Martins, Fabio Y. Hondo, Marcelo S. Lima, Ulysses Ribeiro, Paulo Sakai Surgery of the Alimentary Tract, Cancer Institute of Sao Paulo, Sao Paulo, Brazil Introduction: Most of the patients with head and neck cancer (HNC) present with dysphagia caused by the malignant digestive stenosis usually aggravated by the treatment. In most of them, prolonged nutritional support will be needed. Percutaneous endoscopic gastrostomy (PEG) is considered the method of choice to provide nutritional support to these patients. On the other hand, severe complications related to PEG placement such as acute respiratory distress, metastasis to the gastrostomy site and increased rate of peristomal infection have been associated with HNC patients. Objective: describe the safety profile and the efficacy of two PEG techniquespull and introducer/gastropexy in HNC patients. Methods: retrospective review of prospectively collected data in an academic tertiary referral center. From December 2008 to May 2010, 77 HNC patients (84% male, median age 58,6 y, range 28 to 89 y) were referred to PEG placement. Patients with trismus or severe aerodigestive stenosis were submitted to the introducer technique with gastropexy (Frexapexat-Fresenius Germany) with the aid of a slim (4.9mm) scope (GIF-N180 Olympus Co, Japan). The remaining pts were submitted to standard PEG by the pull technique with a 24 or 20Fr feeding tube (PEGflow Cook, USA). The rates of technical success, complications, morbidity and mortality were determined. Results: PEG placement was possible in 76 patients (98.7%). The absence of transillumination and previous gastrectomy prevented PEG in one pt (1.3%). The pull technique was employed in 65 patients (85.5%) and the introducer technique with gastropexy with a 15 Fr tube, in 11 patients (14.5%). Major complications were observed in 6 (7.8%) and minor complications in 11 (14.4%) of the 76 patients. All the major complications were observed in the pull technique group (6/65pts-9.2%) and included acute respiratory distress in three pts (4,6%) with fatal outcome in one of them (1.5% mortality rate), one case of bleeding (1,5%), one case with buried bumper syndrome (1,5%) and inadvertent early withdrawn of the tube in one pt (1,5%). Minor complications were observed in 5 patients in the pull technique (7,6%) and included granuloma at the PEG site in two pts (3%), peristomal infection in two pts (3%) and local pain in one pt (1,5%). In the introducer/gastropexy technique group minor complications were observed in six pts (54,5%) and included tube dislodgment in four (36,3%), dermatitis in one (9%) and local pain in one pt (9%). Conclusions: PEG is a feasible, safe and effective procedure in HNC patients. Our preliminary data suggest that the pull technique is related to higher rates of severe complications and the introducer/gastropexy technique is associated with more frequent tube dysfunction. Randomized trials are needed to compare the push and introducer/gastropexy techniques in HNC pts.