A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients

Giordano-Nappi, José Humberto; Maluf‐Filho, Fauze; Ishioka, Shinichi; Hondo, Fábio Y.; Matuguma, Sérgio; Lima, Marcelo Simas de; Santos, M. Lera dos; Retes, Felipe Alves; Sakai, Paulo

doi:10.1055/s-0030-1256495

Cited by 13 publications

(30 citation statements)

References 27 publications

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“…Placement was successful in all cases. This is comparable to recent studies, which report a 97.8-100% success rate [15,16] .…”

Section: Discussionsupporting

confidence: 90%

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Schaefer¹,

Vivaldi²,

Herbold³

et al. 2016

Dig Surg

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Background: Percutaneous endoscopic gastrostomy (PEG) placed in the pull through (PT) technique is a common procedure to restore enteral feeding in patients with swallowing disorders. Limitations of this technique are patients with obstruction of the pharynx or esophagus or with an esophageal stent. We report our experience with the direct puncture (DP) PEG device. Methods: We included 154 patients (55 women). One hundred forty patients had cancer. After passing the endoscope into the stomach, 4 gastropexies were performed with a gastropexy device and the PEG was placed with the introducer method. After 1 month, the sutures were removed and a constant gastrocutaneous fistula had been created and the new catheter could be placed safely. Results: The DP PEG was successfully placed in all patients. Overall complication rate was 11% (minor: 6%, major: 5%). The most common event was tube dislocation (40 cases). In 5 cases of dislocation, this resulted in a major complication with injuring the gastric wall and the necessity for surgical treatment. Conclusions: The DP PEG system is safe, and can be used in cases in which a standard PT PEG is not feasible. To avoid dislocation, strict adherence to a post-interventional protocol is highly recommended.

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“…Placement was successful in all cases. This is comparable to recent studies, which report a 97.8-100% success rate [15,16] .…”

Section: Discussionsupporting

confidence: 90%

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Schaefer¹,

Vivaldi²,

Herbold³

et al. 2016

Dig Surg

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show abstract

“…In the literature on patients with cancer, the overall complication and mortality rates of the pull/push method in patients with head and neck cancer are 10.9%-42.0% and 0%-5%, respectively [15,17,18,[20][21][22][33][34][35][36] . An overall complication rate of 0%-11% and mortality rate of 0% have been reported with the introducer method [15,16,37,38] compared with the pull/push method in patients with aerodigestive cancer. In the pull/push method, one reason for the high complication rate may be that it is necessary to dilate the lumen before treatment when the stenosis caused by the tumor is severe.…”

Section: Complicationsmentioning

confidence: 99%

“…This problem was solved by the use of T-fasteners to secure the anterior stomach to the abdominal wall [39,40] . Therefore, recent data on the introducer method using T-fasteners show low complication rates of less than 11% and no mortality [38,[41][42][43][44][45] . However, Dyck's study shows that severe short-term complications may occur in patients with esophageal or head and neck tumors after place- ment of the introducer PEG tube with T-fasteners, leading to urgent surgical intervention and even death in a substantial number of patients [20] .…”

Section: Complicationsmentioning

confidence: 99%

Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

Ogino

Akiho²

2013

WJGP

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Aerodigestive cancer, like esophageal cancer or head and neck cancer, is well known to have a poor prognosis. It is often diagnosed in the late stages, with dysphagia being the major symptom. Insufficient nutrition and lack of stimulation of the intestinal mucosa may worsen immune compromise due to toxic side effects. A poor nutritional status is a significant prognostic factor for increased mortality. Therefore, it is most important to optimize enteral nutrition in patients with aerodigestive cancer before and during treatment, as well as during palliative treatment. Percutaneous endoscopic gastrostomy (PEG) may be useful for nutritional support. However, PEG tube placement is limited by digestive tract stenosis and is an invasive endoscopic procedure with a risk of complications. There are three PEG techniques. The pull/push and introducer methods have been established as standard techniques for PEG tube placement. The modified introducer method, namely the direct method, allows for direct placement of a larger button-bumper-type catheter device. PEG tube placement using the introducer method or the direct method may be a much safer alternative than the pull/push method. PEG may be recommended in patients with aerodigestive cancer because of the improved complication rate.

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“…Estenoses benignas ou malignas do trato aerodigestivo impedem ou dificultam a realização do procedimento em até 20% dos casos (25)(26)(27) . Frente a esta situação, faz-se necessária a dilatação da estenose, associando-se à GEP os riscos inerentes à dilatação, principalmente perfuração e hemorragia (28) .…”

Section: Introductionunclassified

“…Também em 1980, Hashiba (29) (31)(32)(33) . Desde então, inúmeras modificações foram sugeridas a fim de tornar a técnica de introdução com gastropexia mais simples, segura e permitir a introdução de sondas mais calibrosas (27,(31)(32)(33)(34)(35) .…”

Section: Introductionunclassified

Gastrostomia endoscópica em pacientes com neoplasia de cabeça e pescoço: comparação da técnica de introdução com gastropexia e técnica de tração

Retes¹

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A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients

Abstract: The device modification for PEG using the introducer technique is feasible, safe, and efficient in outpatients with obstructive head and neck cancer. In this series, it allowed the use of a larger-caliber tube with low complication rates and no procedure-related mortality.

Cited by 13 publications

References 27 publications

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Percutaneous Endoscopic Gastrostomy in Direct Puncture Technique: When, Why and How?

Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer

Gastrostomia endoscópica em pacientes com neoplasia de cabeça e pescoço: comparação da técnica de introdução com gastropexia e técnica de tração

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