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. 1989 Jul;210(1):42–46. doi: 10.1097/00000658-198907000-00006

Percutaneous endoscopic gastrostomy in head and neck cancer patients.

J G Hunter 1, L Lauretano 1, P C Shellito 1
PMCID: PMC1357763  PMID: 2500899

Abstract

Unique problems accompany percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients. This study analyzed the experience of one surgeon (P.S.) performing PEG in 50 patients with advanced oropharyngeal cancer. The records of 54 such patients consecutively referred for PEG at the Massachusetts General Hospital were reviewed. A pull-through PEG technique was used. The procedure was successful in 50 patients (success rate, 93%). Failures were caused by esophageal stricture, respiratory distress, and hiatus hernia. The two patients with insurmountable esophageal stricture had piriform sinus tumors. Cancer in this location and pharyngoesophageal strictures were predictive of PEG failure. A single death, 21 days after endoscopy, was caused by pneumonia. The only major complications were two transient respiratory arrests. Neither patient had a tracheostomy in place, and both had unresected cancer present. Minor complications were transient gastroparesis, pneumonia, unexplained fever, and a broken traction suture. There were no wound or intraabdominal infections and no episodes of bleeding. While PEG was successful in 93% of these difficult patients, with few complications, results could be improved by tracheostomy or resection performed before PEG in patients with tumors near the airway and dilatation of troublesome esophageal strictures under endoscopic view before PEG.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Cave D. R., Robinson W. R., Brotschi E. A. Necrotizing fasciitis following percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1986 Aug;32(4):294–296. doi: 10.1016/s0016-5107(86)71852-x. [DOI] [PubMed] [Google Scholar]
  2. Greif J. M., Ragland J. J., Ochsner M. G., Riding R. Fatal necrotizing fasciitis complicating percutaneous endoscopic gastrostomy. Gastrointest Endosc. 1986 Aug;32(4):292–294. doi: 10.1016/s0016-5107(86)71851-8. [DOI] [PubMed] [Google Scholar]
  3. Jain N. K., Larson D. E., Schroeder K. W., Burton D. D., Cannon K. P., Thompson R. L., DiMagno E. P. Antibiotic prophylaxis for percutaneous endoscopic gastrostomy. A prospective, randomized, double-blind clinical trial. Ann Intern Med. 1987 Dec;107(6):824–828. doi: 10.7326/0003-4819-107-6-824. [DOI] [PubMed] [Google Scholar]
  4. Jonas S. K., Neimark S., Panwalker A. P. Effect of antibiotic prophylaxis in percutaneous endoscopic gastrostomy. Am J Gastroenterol. 1985 Jun;80(6):438–441. [PubMed] [Google Scholar]
  5. Kirby D. F., Craig R. M., Tsang T. K., Plotnick B. H. Percutaneous endoscopic gastrostomies: a prospective evaluation and review of the literature. JPEN J Parenter Enteral Nutr. 1986 Mar-Apr;10(2):155–159. doi: 10.1177/0148607186010002155. [DOI] [PubMed] [Google Scholar]
  6. Larson D. E., Burton D. D., Schroeder K. W., DiMagno E. P. Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. Gastroenterology. 1987 Jul;93(1):48–52. [PubMed] [Google Scholar]
  7. Martindale R., Witte M., Hodges G., Kelley J., Harris S., Andersen C. Necrotizing fasciitis as a complication of percutaneous endoscopic gastrostomy. JPEN J Parenter Enteral Nutr. 1987 Nov-Dec;11(6):583–585. doi: 10.1177/0148607187011006583. [DOI] [PubMed] [Google Scholar]
  8. Miller R. E., Kummer B. A., Tiszenkel H. I., Kotler D. P. Percutaneous endoscopic gastrostomy. Procedure of choice. Ann Surg. 1986 Nov;204(5):543–545. doi: 10.1097/00000658-198611000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Nichols R. L., Webb W. R., Jones J. W., Smith J. W., LoCicero J., 3rd Efficacy of antibiotic prophylaxis in high risk gastroduodenal operations. Am J Surg. 1982 Jan;143(1):94–98. doi: 10.1016/0002-9610(82)90136-2. [DOI] [PubMed] [Google Scholar]
  10. Ponsky J. L., Gauderer M. W. Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc. 1981 Feb;27(1):9–11. doi: 10.1016/s0016-5107(81)73133-x. [DOI] [PubMed] [Google Scholar]
  11. Ponsky J. L., Gauderer M. W., Stellato T. A., Aszodi A. Percutaneous approaches to enteral alimentation. Am J Surg. 1985 Jan;149(1):102–105. doi: 10.1016/s0002-9610(85)80017-9. [DOI] [PubMed] [Google Scholar]
  12. Ruppin H., Lux G. Percutaneous endoscopic gastrostomy in patients with head and neck cancer. Endoscopy. 1986 Jul;18(4):149–152. doi: 10.1055/s-2007-1018358. [DOI] [PubMed] [Google Scholar]
  13. Shellito P. C., Malt R. A. Tube gastrostomy. Techniques and complications. Ann Surg. 1985 Feb;201(2):180–185. doi: 10.1097/00000658-198502000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Stern J. S. Comparison of percutaneous endoscopic gastrostomy with surgical gastrostomy at a community hospital. Am J Gastroenterol. 1986 Dec;81(12):1171–1173. [PubMed] [Google Scholar]

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