Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates

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Authors/Editors

Makubate, Boikanyo

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Publication Details

Author list: McAllister P, MacIver C, Wales C, McMahon J, Devine JC, McHattie G, Makubate B

Publisher: Elsevier

Place: EDINBURGH

Publication year: 2013

Journal: British Journal of Oral and Maxillofacial Surgery (0266-4356)

Journal acronym: BRIT J ORAL MAX SURG

Volume number: 51

Issue number: 8

Start page: 714

End page: 718

Number of pages: 5

ISSN: 0266-4356

Languages: English-Great Britain (EN-GB)

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Abstract

Patients with head and neck cancer who have resection, radiotherapy, chemoradiotherapy, or a combination of these require nutritional support to be implemented before treatment, and this may involve insertion of a prophylactic gastrostomy feeding tube. The aim of this study was to compare the use and complication rates of percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) in these patients at a tertiary referral centre. We retrospectively reviewed gastrostomy data forms completed by nutritional support nursing staff over a recent 34-month period, which included information on method of insertion, 30-day postoperative serious and minor complications, and mortality. A total of 110 patients had prophylactic insertion of a gastrostomy (21 PEG, 89 RIG) over the study period. In the first 12 months 13 (31%) PEG feeding tubes were placed but in the last 12 months none were inserted using an endoscopic approach. Serious complications occurred with 2(10%) PEG and 12(13%) RIG; the most common cause was accidental removal of the tube (n = 13, 12%). Minor complications of peristomal infection, leakage, or blockage of the tube occurred in 6 (5%) gastrostomies. No patients died during the study period. In recent years, and in the absence of recommended guidelines, there has been an increase in the elective insertion of RIG in patients with head and neck cancer. Serious complications for both methods of insertion in this study are comparable with similar reports. However, with RIG there is a high rate of tubes becoming dislodged with the potential for serious consequences. The most appropriate method to insert a gastrostomy tube in patients with head and neck cancer remains unclear. Crown Copyright (C) 2013 Published by Elsevier Ltd. on behalf of The British Association of Oral and Maxillofacial Surgeons. All rights reserved.

Keywords

Gastrostomy, Head and neck cancer, Nutrition, PEG, RIG

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