Both modalities are necessary in posttreatment surveillance. MRI shows the highest PPV, whereas endoscopy trends toward a higher specificity. PET/CT scans have a high false-positive rate and should be reserved for tumors with a high propensity for distant metastases. © 2016 Wiley Periodicals, Inc. Head Neck 38:1229-1233, 2016.

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Objectives: The objectives of the study were to compare the indications, adverse events, removal rates, and mortality of percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) techniques at our tertiary care institution from 2014 to 2019. Material and Methods: We undertook a 5-year retrospective review of patients who underwent either PEG or PRG at our institution from 2014 to 2019. Common adverse events include tube clogs, leaks, minor bleeds, and wound infections, while more rare major complications include peritonitis, intra-abdominal infection, and major hemorrhage. The procedures were all performed with either conscious sedation or general anesthesia. A total of 789 patients were reviewed, of whom 519 (65.8%) had a PRG and 270 (34.2%) had a PEG. PRGs were more likely to be placed for head-and-neck cancer (P < 0.0001) and amyotrophic lateral sclerosis (P < 0.0001), while PEGs were more likely to be placed for gastric outlet obstruction (GOO) (P <.0001) and malnutrition (P < 0.0001). Results: The rate of major adverse events was similar between the two groups (P = 0.938). GI placed gastrostomy tubes were more likely to have a minor adverse event (P < 0.0001), however, this was secondary to a significant increase in tube clog in the PEG/J group as compared to PEG (P < 0.0001). Conclusion: The decision to place a PEG or PRG should be individualized to the patient’s specific condition and indication. Both procedures have favorable safety profiles, and it is likely that institutional expertise and procedural access will be the primary determinants of the procedural technique chosen for minimally invasive gastrostomy.

pain (83%), diarrhea (67%), hematochezia (42%), iron deficiency anemia (8%), and/ or elevated C-reactive protein level (CRP; 8%). Of those with imaging (nZ11), one showed terminal ileum dilatation whereas the rest were normal. All patients underwent upper endoscopy (EGD) with duodenal erythema (25%), erosions (17%), nodularity (17%), friability (8%), or congestion (8%). Of those who underwent ileoscopy or colonoscopy (nZ9), small bowel/terminal ileum findings included erosions (22%), ulcers (11%), and dilatation (11%). All VCEs were abnormal with small bowel findings of erosions (83%), inflammatory changes (erythema, edema, and granularity; 83%), ulcerations (75%), and blood/hematin (50%). Both patients without abdominal pain had disease on VCE, as did all three patients without anemia and all three patients without elevated CRP. Of those with EGD, VCE, and colonoscopy evaluation (nZ11), disease was seen in all three modalities in 72.7%, VCE and colonoscopy only in 18.2%, or EGD and VCE only in 9.1%. Conclusions: CGD patients with GI symptoms often have active small bowel disease. In such patients, small bowel disease should be investigated, and therapy should seek to address any small bowel involvement. These interim results support continued exploration and characterization of small bowel disease in CGD and its optimal diagnostic modality.

Several research studies have shown that code status documentation is misinterpreted or incorrectly defined by a significant number of medical professionals. This misinterpretation among the medical team (i.e. equating Do Not Resuscitate (DNR) with comfort care measures only) may lead to false reporting, poor symptom management, and potentially adverse clinical outcomes. Most Hospice and Palliative Care providers are aware of these distinctions, however a shortage (and continued foreseen shortage) of Hospice and Palliative Care providers may mean these conversations and distinctions will fall to non-subspecialists, or providers of other medical specialties or degrees. The literature has demonstrated that these shortfalls and misinterpretations are present and constitute potential harm to our patients.