PEG Placement Research Articles

New Suction-Aid Bite Block Enables Continuous, Hands-Free Suction and Provides Greatly Improved Patient Comfort and Procedure Efficiency

Purpose: Recent advancements in gastroenterology have led to increasingly complex and lengthy diagnostic and therapeutic procedures involving the upper gastrointestinal tract. Frequent suctioning of the mouth is needed to remove oral secretions and prevent aspiration. The suctioning is usually done by the endoscopy assistant who also performs other functions. The suction catheter needs to be physically held in place by the assistant, causing delays in performing biopsies or procedures to control gastrointestinal hemorrhage. Methods: We developed Suction Aid bite block with several modifications to the traditional bite block. Results: Our bite block features multiple openings to allow stable positioning of various sizes of suction catheters, which remain in a fixed position in the mouth, thereby allowing continuous hands-free suction. This eliminates the need for the endoscopy assistant to hold on to the suction catheter. With continuous hands-free suction, patient monitoring and comfort are improved. The endoscopist and endoscopy assistant can focus on timely completion of the diagnostic or therapeutic procedure. This patent pending device has been successfully utilized in various upper endoscopic procedures such as EGD, EUS, ERCP, PEG placement, and small bowel enteroscopy. Conclusion: Our new Suction Aid bite block designed for use in any upper gastrointestinal endoscopy procedure and can accommodate various commonly used suction cannulae. It will improve patient comfort and help the endoscopist and endoscopy assistant in managing efficiency of the procedure.

Leakage from Surgical Jejunostomy Tube Due to Sharp Angle of Efferent Limb

Purpose: 30 year old male with mental retardation, cerebral palsy and seizures was admitted in October 2004 for respiratory distress from pneumonia. He was intubated and after extubation, he developed dysphagia. A gastroenterologist attempted percutaneous endoscopic gastrostomy tube (PEG) placement but was unsuccessful since no transillumination was seen. Surgery was then consulted. They tried to do an endoscopic PEG in the operating room without success. Upon laparotomy the stomach was found to be higher than normal in the area under the costal margins and could not be pulled down. After multiple attempts to reposition the stomach, PEG placement was determined to be impossible due to a result of increased tension on the stomach. A jejunostomy tube was therefore placed 20 cm distal to the ligament of Treitz. The patient has had about 30 feeding tube changes over the following 3 years due to chronic tube leakage. He suffered from extensive skin breakdown and infections surrounding the jejunostomy tube making it difficult for the family to take care of him. The patient's father as well as medical staff had changed the jejunostomy tubing as a standard blind procedure and time after time, leakage continued to occur. Different sized tubes were attempted without success. When he was referred to us we took him to GI lab for endoscopic evaluation and replacement of the jejunostomy tube. After entering approximately 2 cm through the stoma with a 6 mm slim nasal upper endoscope, a division with an afferent and efferent limb was seen. The limb slightly to the right and straight ahead was assumed to be the afferent limb from the stomach. Instead we took a very sharp left turn and advanced 50 cm down with the endoscope. A Savary guidewire was placed through the scope, the scope withdrawn, and then a 45 cm jejunal feeding tube was threaded over it. Radiology confirmed that this was the efferent limb. Leakage from the feeding tube has since reduced dramatically and the skin has healed. When jejunostomy feeding tubes repeatedly leak despite multiple tube changes, it is recommended to perform an endoscopic guided tube change with an upper nasal endoscope. In this case, during blind tube changes, the tube most likely repeatedly entered the pathway of least resistance, which was in the limb leading towards the stomach. This caused tube feeds to travel back out the tube or exit the space surrounding the tube.

Porous Orbital Implants, Wraps, and Peg Placement in the Pediatric Population After Enucleation

To investigate complications of various porous orbital implants and wrapping materials in the pediatric population after enucleation. A retrospective, comparative, nonrandomized study. Between November 1992 and November 2006, patients younger than 15 years old were collected for study participation. They underwent enucleation with porous orbital implants primarily or secondarily at National Taiwan University Hospital. The authors used the hydroxyapatite (HA), Medpor, and Bioceramic orbital implant. The HA implant was wrapped with four different materials: donor sclera, Lyodura, porcine sclera, and Vicryl mesh. A part of HA implants and all bioceramic implants were wrapped with Vicryl mesh, added anteriorly with scleral patch grafts. All Medpor implants were unwrapped. Forty-seven cases had more than a two-year follow-up. The exposure rates according to implants and wraps were: donor sclera-wrapped HA (two of nine, 22%), porcine sclera-wrapped HA (three of three, 100%), Vicryl mesh-wrapped HA (one of five, 20%), and unwrapped Medpor (one of four, 25%). No exposure was found in four Lyodura-wrapped HA implants, and 22 Vicryl mesh-wrapped HA and Bioceramic implants with anteriorly scleral coating. The exposure rate was lower in cases with implants wrapped by our method and Lyodura than in those with implants wrapped by other materials (P < .001). Of 47 patients, 20 (42.5%) were fitted with peg-coupled prostheses and all had good prosthetic movements subjectively. Different types of implants and wraps resulted in various exposure rates in the pediatric population. The modified wrapping technique may prevent porous implants from exposure in children.

True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study

True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study

Complications of Orbital Implants: A Review of 542 Patients Who Have Undergone Orbital Implantation and 275 Subsequent Peg Placements

Purpose: To inform patients and physicians of the complications associated with three commonly used orbital implants, as well as associated anophthalmic socket issues. Methods: A retrospective chart review of 542 patients who underwent eviscerations, enucleations and secondary procedures by one surgeon (Dr. James Oestreicher) was completed, paying special attention to complications in the follow-up period prior to pegging, as well as those that occurred post-pegging. Results: Approximately 60% of patients experienced complications prior to implant drilling, with discharge being the most prevalent (15.9%). Secondary procedures were associated with significantly greater complication rates prior to implant drilling. Silicone implants had significantly less pre-pegging pyogenic granuloma (P = 0.011) and hypo-ophthalmos (P = 0.042) than the other implant types. Seven implants had to be removed due to exposure. Implant drilling and peg placement were performed in 275 patients. Implant drilling complications were experienced by 67.4% of pegged patients, with a change in discharge from prior to pegging (27.2%) being the most prevalent. Plastic peg systems had a significantly higher incidence of complications than titanium systems. Conclusions: The majority of orbital implantations involve complications, these being largely minor ones which resolve spontaneously or are easily treated. Secondary implant procedures involve a higher likelihood of complications. Silicone implants have the smallest amount of complications. Should patients decide to undergo pegging, evidence sides strongly for the use of a titanium peg and sleeve system over the other peg types. Implant removal is a rare event; occurring in 1.3% (n = 7) of the study population.

Should single-stage PEG buttons become the procedure of choice for PEG placement in children?

Should single-stage PEG buttons become the procedure of choice for PEG placement in children?

True incidence and clinical significance of pneumoperitoneum after PEG placement: a prospective study

PEG is a widely used method for providing nutritional support. Although pneumoperitoneum is a known finding after PEG placement, its true incidence is subject to debate. Small retrospective studies have found varied rates of free air after PEG placement. There were a total of 65 patients. To assess the true incidence of pneumoperitoneum and its clinical significance. Prospective study. Long Island Jewish Medical Center. We obtained upright and anterior-posterior chest radiographs of 65 patients within 3 hours after PEG placement. Type of PEG tube, gauge of the needle used, number of sticks, and indications were recorded. The presence of pneumoperitoneum on the initial chest film was considered to be a positive finding. After a positive result, a repeat chest film was obtained 72 hours later to determine whether there was progression or resolution of the free air. Patients enrolled in the study were also monitored clinically for evidence of peritonitis. Of the 65 patients who underwent PEG placement, 13 developed a pneumoperitoneum on the initial chest radiograph; there was complete resolution of pneumoperitoneum at 72 hours in 10 of the 13 patients. In 3 patients, the free air persisted but was of no clinical significance. The free air was quantified by measuring the height of the air column under the diaphragm and was graded with a scoring system (0, no air; 1, small; 2, moderate; 3, large). Eleven patients who underwent PEG died during the hospitalization; none of the deaths were related to the PEG placement or pneumoperitoneum. The other 54 patients were discharged to a skilled nursing facility. No patients in the study had clinical evidence of peritonitis. There were no adverse events, ie, infection or bleeding, associated with the PEG placement in any of the patients. Our data suggest that pneumoperitoneum after PEG placement is common and, in the absence of clinical symptoms, is of no clinical significance and does not warrant any further intervention.

Use of double-balloon enteroscopy to perform PEG in the excluded stomach after Roux-en-Y gastric bypass

Because of postoperative complications, patients who have undergone Roux-en-Y gastric bypass (RYGB) for weight loss may require radiographic investigation of the pancreaticobiliary limb or enteral feeding. Gastrostomy-tube placement into the excluded stomach for these indications is typically performed surgically or via fluoroscopic or US guidance; PEG has not been reported as being performed for this purpose. Successful examination of the excluded stomach after RYGB has been reported when using double-balloon enteroscopy (DBE). To perform PEG in the excluded stomach by using DBE. Retrospective review. Single, North American tertiary-care center. Individuals with postoperative complications after RYGB that requires radiographic examination of the excluded stomach and the pancreaticobiliary limb, or enteral feeding. Performance of PEG within the excluded stomach by using DBE. Ability to perform PEG-procedure-related complications and resultant management changes. PEG was successfully performed by using DBE in 3 of 4 patients with postoperative complications after RYGB. In 2 of the cases, the results of radiographic studies performed with contrast administration through the gastrostomy tube led to significant operative management changes. In the third case, preoperative enteral nutrition was provided by using a gastrostomy tube. PEG placement was not possible in the fourth case because of the lack of abdominal transillumination. Major complications were not observed. Small sample size, single-center experience. PEG placement in the excluded stomach after RYGB by using DBE was safe, technically feasible, and led to management changes in patients in whom it was performed. This procedure should be added to the growing list of indications for DBE.

Prophylactic PEG Placement Prevents Exacerbation of Weight Loss during Chemo-Radiation for Head and Neck Cancer Patients

Purpose: In addition to generalized risk factors of anorexia and cachexia, head and neck cancer patients receiving chemo-radiation therapy are at risk for significant weight loss secondary to mucositis and the odynophagia/dysphagia caused by radiation injury to the esophagus. It is routine practice to prophylactically place a percutaneous endoscopic gastrostomy tube prior to the initiation of chemo-radiation in this population. The value of prophylactic placement has been questioned as some patients never require to utilize the PEG after it has been placed. Outcome parameters of PEG placement were studied in head and neck cancer patients referred routinely for a PEG prior to chemo-radiation. Specifically, we were focused on whether patients utilized the PEG at all for maintenance of hydration or nutrition, and if so, whether utilization of the PEG allowed patients to maintain their weight compared to patients who did not use the PEG. Methods: A retrospective chart review was performed on 34 consecutive patients who underwent PEG placement prior to beginning combination chemo-radiation for head and neck cancers. Use of the PEG tube and body weights were assessed 12 to 16 weeks after initiation of therapy. The same attending gastroenterologist supervised PEG placement and follow up of each patient. Results: 5 patients were lost to follow-up, allowing for analysis of 29 patients. 6/29 (20.7%) patients did not end up using the PEG at all for hydration or nutrition. 7/29 (24.1%) patients used the PEG exclusively, due to severe limitations of oral intake. 16/29 (55.2%) patients used the PEG to supplement limited oral intake. Over all average weight loss was 8.0 kg per patient; a reduction in usual body weight (UBW) of 9.9%. Among the patients who never used their PEG the average weight loss was 8.7 kg; a reduction in UBW of 10.3%. Of the patients who used the PEG exclusively, the average weight loss was 8.6 kg; a reduction in UBW of 10.7%. Conclusions: The routine prophylactic placement of a PEG tube prior to chemo-radiation for head and neck cancer patients was utilized to some extent by the majority of patients (79.3%). Patients utilizing the PEG tubes to overcome limitations in oral intake secondary to the chemo-radiation were able to maintain their weight as well as patients who did not experience any limitations in oral intake secondary to the therapy. This data supports the routine placement of PEG tubes prior to chemo-radiation for head and neck cancer patients.

Preoperative Anesthetic Cream Decreases Incisional Pain in Patients with Amyotrophic Lateral Sclerosis Undergoing Gastrostomy Placement

Purpose: Our division of Gastroenterology has become increasingly involved in the nutritional management of patients with Amyotrophic Lateral Sclerosis (ALS). As part of their care, gastrostomy placement (PEG) has become routine. We have observed that ALS patients experience incisional pain during placement of PEG despite adequate conscious sedation and a local lidocaine injected subcutaneously. To minimize discomfort we have made it standard protocol to apply an analgesic cream prior to PEG placement. Methods: 47 patients with ALS have undergone successful PEG placement at our institution. The initial 18 patients experienced incisional pain. The following 29 patients had either EMLA Cream® (2.5% lidocaine and 2.5% prilocaine, AstraZeneca) or LMX Cream® (4% lidocaine, Ferndale) applied to the abdomen preoperatively. All patients were assessed in the recovery room prior to discharge. Results: Of the 29 patients receiving preoperative analgesic cream, only 1 expressed moderate incisional pain. The remaining 28 were relatively symptom free during and after their procedures. Conclusions: 1. Patients with ALS appear to have heightened pain sensation. 2. Our observations suggest that preoperative application of an analgesic cream greatly diminishes operative and post operative pain.

Should single-stage PEG buttons become the procedure of choice for PEG placement in children?

Single-stage PEG buttons (PEG-B) allow initial placement of a skin-level gastrostomy device for children who require enteral access. They offer significant advantages over traditionally placed PEG tubes (PEG-T) but have not been widely accepted into practice. To review our experience with PEG-Bs compared with PEG-Ts. PEG-B shares a similar safety profile with PEG-T but delays the need for an initial device change well beyond the change that usually occurs at 6 to 8 weeks after PEG-T placement. Retrospective chart review. Nemours Children's Clinic, Jacksonville, Florida. All children undergoing both PEG procedures and attending our clinic from 1997 to 2002. Age, sex, weight, indications, postoperative complications, interval until first tube change and first tube change complications. Totals of 145 and 93 patients were identified in the PEG-B and PEG-T groups, respectively. Patient characteristics were similar in the 2 groups with respect to age, weight, indications, and postoperative complications. The interval until first tube change, however, was significantly longer in the PEG-B group (314 days) than in the PEG-T (78 days) (P < .0001). In addition, the PEG-B was found to be as safe as the PEG-T for small infants who weighed less than 5 kg. PEG-B placement should be considered as the procedure of choice over PEG-T placement for children. It offers similar safety profiles, even for small patients and a significantly longer interval until first device change.

Does gastro-oesophageal reflux following PEG placement in stroke patients predict a poorer outcome?

Does gastro-oesophageal reflux following PEG placement in stroke patients predict a poorer outcome?

A Solution to the Failed PEG Procedure: EUS-FNA Guided PEG Placement

A Solution to the Failed PEG Procedure: EUS-FNA Guided PEG Placement

The Safety of Percutaneous Endoscopic Gastrostomy Tube Placement in Patients With Existing Ventriculoperitoneal Shunts

Because the insertion of percutaneous endoscopic gastrostomy tubes (PEG) involves disruption of the gastrointestinal tract with potential peritoneal contamination, patients with indwelling ventriculoperitoneal (VP) shunts could be at increased risk of meningitis, a potentially devastating infection. The safety of PEG placement in the presence of a VP shunt is unclear. A retrospective chart review was performed that included all adult patients with existing VP shunts requiring PEG placement at a single university medical center over an approximate 9-year period from July 1995 to March 2004. Thirty-nine patients who underwent PEG placement 2-564 days after shunt placement were identified. Two patients (5%) subsequently developed meningitis. Cerebrospinal fluid cultures demonstrated Staphylococcus aureus and Enterococcus faecalis. These infections occurred 2 and 15 months after PEG placement, respectively. At the time of PEG placement, 17 patients (44%) were receiving antibiotics for reasons other than operative prophylaxis, and 11 patients (28%) received prophylactic antibiotics. Both infected patients had received antibiotics at the time of PEG placement. These data constitute the largest series of patients with existing VP shunts undergoing PEG placement reported to date. When compared with the published 2%-5% infection rate for patients with VP shunts alone, our data do not suggest an increased risk of infection for patients after PEG placement. As the total number of adult patients requiring a PEG after VP shunt placement is low, multicenter studies should be carried out to better stratify this risk.

Buried Bumper Syndrome complicated by intra-abdominal sepsis

There is growing evidence that enteral feeding tubes are associated with increased mortality and complication rates in patients with advanced dementia. Buried Bumper Syndrome is an uncommon, but well documented late complication of PEG placement. Our case report reinforces this recognised risk of PEG feeding in an elderly, cognitively impaired patient.

Incidence of abdominal wall metastasis complicating PEG tube placement in untreated head and neck cancer

Abdominal wall metastasis after PEG tube placement has been reported in patients with head and neck cancer. The incidence of this occurrence is unknown. Evaluation of the incidence of abdominal wall metastasis as a complication of PEG tube placement in patients with head and neck cancer. Retrospective chart review. H. Lee Moffitt Cancer Center and Research Institute, Nutritional Support Services. Head and neck cancer patients requiring nutritional support with PEG tube placement. Of the 304 patients with head and neck cancer, 218 had active disease with a viable tumor in the oropharynx or hypopharynx at the time of PEG placement. Two of these patients, both with active disease (0.92%), developed a PEG site metastasis. There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk. Use of other percutaneous techniques that do not involve traversing the hypopharynx with the catheter may help to prevent tumor translocation. When head and neck cancers metastasize to the gastrostomy site, patient survival appears limited even with extensive resection.

Should Percutaneous Endoscopic Gastrostomy (PEG) Be Used in Intensive Care Unit Patients?

Purpose: With rising health care costs, a current trend is to use PEG to shorten hospital length of stay (LOS) and to expedite discharge to the nursing home (NH). Because of this trend, gastroenterologists increasingly are being asked to perform PEGs in acutely ill patients with multiple comorbidities. To determine mortality in patients from medical intensive care units (MICU) versus the medical floors on whom PEG consults had been requested? Methods: A sample of 191 consecutive patients [mean age of 81 (range 49–105 yrs), 58% female and 81% from NH] referred for PEG placement were included. Patient age, gender, BMI, race, community vs. NH, new PEG vs. replacement, reason for PEG, MICU vs. floor, LOS, clinical lab values, comorbidity, nutritional status classification score and outcome (discharge vs. death) were collected. The data was examined using Student t-tests, chi-square analysis and logistic regression analysis. Results: MICU and medical floor patients had similar age (P = .0736) and gender distribution (P = .278). Significantly more MICU patients came from the community vs. NH (41% vs. 15%, P = .002). Also, a significantly higher proportion of MICU patients died compared to medical floor patients (59% vs. 18%, P < .0005). Deaths were similar in new PEG and replacement PEG patients (P = .859). MICU patients had significantly longer LOS (mean of 56 vs. 18 days, P = .0240) but similar mean BMI (P = .5123) and nutritional risk assessment scores (P = .457) when compared with medical floor patients. Logistic regression analysis determined that deaths were 93% more likely to occur in MICU patients (P < .0005), independent of the 10% decreased risk of death for every 1-unit increase in BMI (>11), and independent of the >15 million-fold likelihood of death in patients with moderately compromised (P < .0005) or severely compromised (P < .0005) nutritional status classification. Further, age, gender, race, place of residence (community vs. NH) and LOS were not risk factors for death in this sample of PEG consult patients. Conclusions: MICU patients are more severely ill than patients on the floors and may not survive long enough to benefit from PEG. It may be more reasonable to use nasogastric tubes for feeding and allow a “cool off” period between getting a consult for PEG and actually inserting a PEG.Future studies should work to identify both positive and negative factors associated with death in MICU patients to aid gastroenterologists in their decisions regarding PEG insertions.

Risk of Death among Percutaneous Endoscopic Gastrostomy (PEG) Consult Patients

Purpose: There is limited data on which subset of patients will benefit most from feeding via PEG. The procedure was originally designed for use in patients with neurological disorders. With rising health care costs, the present trend is to use PEG to shorten length of stay (LOS) and to expedite discharge to the nursing home (NH). Objective: To identify those variables that are likely to predict an increased risk of mortality in patients undergoing PEG. Methods: sample of 191 consecutive patients [mean age of 81 yrs (range 49–105 yrs), 58% female and 81% from NH] referred for PEG placement between March 2003 and March 2005 were examined at our University teaching hospital. Twenty-one percent of patients were being seen for new PEG insertion vs. 79% for replacement PEG. Data on patient age, gender, BMI, race, community vs. NH, new PEG vs. replacement, reason for PEG, MICU vs. floor, LOS, clinical lab values, comorbidity, nutritional status classification score and outcome (discharge vs. death) was collected. Results: Logistic regression analysis determined that mortality was predicted by [figure 1] but was not predicted by patient age, gender, community vs. NH, race, new vs. replacement PEG, asthma, cancer, CHF, dementia, diabetes, hypothyroidism or deep vein thrombosis. Conclusions: This study identified 10 significant predictors of mortality among PEG consult patients. These findings could be useful in the evaluation of patients prior to PEG placement.Figure

Lung Function and Cognitive Ability in a Longitudinal Birth Cohort Study

The objective of this study was to examine the association between forced expiratory volume in 1 second (FEV1) and cognitive ability in midlife in the normal population. Multiple regression was used to test associations between FEV1 and cognitive function in 1778 men and women in the MRC National Survey of Health and Development, also known as the British 1946 birth cohort. Analyses were adjusted for sex, body size (birth weight, adult height, weight, and chest circumference), socioeconomic status, lifetime smoking, and a range of health indicators, including early respiratory vulnerability (infant lower respiratory infection, childhood asthma, and exposure to atmospheric pollution). FEV1 at 43 years was associated with slower psychomotor speed (peg placement) at the same age and with slower decline in psychomotor speed (letter search speed) from 43 to 53 years, independently of the previously mentioned potential confounders. These independent associations were not observed, however, for adult verbal ability, verbal memory, or rate of decline in memory, which were significantly explained by socioeconomic status and adolescent cognitive ability. In a subsequent analysis, adolescent cognition was positively associated with FEV1, although not with rate of decline in FEV1 from 43 to 53 years, again independently of the previously mentioned confounders. Cognitive function and FEV1 are positively associated across the life course. One possible explanation lies in the parallel action of endocrine, autonomic, and motor control systems on respiration and higher mental function. Because respiration and mental function are both associated with functional capacity and survival, this is a matter of potential clinical significance.

Intensity-modulated radiation therapy (IMRT) for advanced oropharyngeal carcinoma: The MSKCC experience

5513 Background: Retrospective review of an institution’s experience using IMRT for advanced oropharyngeal carcinoma. Methods: Between 9/98 and 6/04, 43 patients with oropharyngeal cancer underwent definitive IMRT at our institution. The disease was stage III in 7 (16%), and stage IV in 36 (84%) patients. Concurrent chemotherapy (CT) was used in 95% and consisted of planned 2–3 cycles every 3–4 weeks of cisplatin (100 mg/m2 IV in 71%), or carboplatin/5-fluorouracil (70 mg/m2/day IV and 600 mg/m2/day continuous infusion, both for 4 days, in 29%). Patients were treated using 2 different IMRT approaches: 74% Dose Painting and 26% Concomitant Boost (CB). The prescription dose to the gross tumor was 70 Gy. Feeding tubes (PEGs) were placed before treatment in 91% of the patients. Acute toxicity and late xerostomia were graded according to the RTOG radiation morbidity scoring criteria. Other complications were evaluated using subjective criteria such as the presence of esophageal stricture and the need for PEG usage. The local (LPF), regional progression-free (RPF), distant metastases-free (DMF) rates, and overall survival (OS) were calculated using Kaplan-Meier method. Median follow-up was 15.2 months (range 5.8–74). Results: The 2-year estimates of LPF, RPF, DMF and OS were 97.2%, 85%, 72.4% and 100% respectively. Two patients required a RT treatment break. The worst acute mucositis experienced were Grade 1 in 2 (5%), Grade 2 in 22 (51%), and Grade 3 in 19 (44%) patients. Xerostomia decreased with time and among the patients (22) with at least 9 months of follow up there were 68% of Grade 0–1 and 32% of Grade 2 toxicity. Of the 39 patients who required upfront PEG placement, 6 were still using PEGs for nutrition at the time of this analysis. Two patients had cervical esophageal strictures: one was still PEG dependent 1 year post treatment, and the other required routine esophageal dilatations. Both were treated using CB. There was no difference in the time to end PEG nutrition between both IMRT groups (p=0.9). Conclusions: In these preliminary results, IMRT achieved encouraging local control rates in patients with advanced oropharyngeal carcinoma. Treatment toxicity was acceptable in the setting of concomitant CT. No significant financial relationships to disclose.