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

Abstract

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.

Gradual tube dilation method before percutaneous endoscopic gastrostomy for obstructive esophageal cancer

“…PEG is a well-known nutritional management method used in patients with terminal cancer [5,13]. The use of an UTNE has been shown to decrease the incidence of aspiration pneumonia in elderly and bedridden patients [14], and it now makes it possible to perform PEG in patients with stenosis of the tract to the stomach [7].…”

“…It is being increasingly recognized that PEG is a simple and safe procedure [2][3][4]. Therefore, PEG is now widely used to support the long-term nutrition in patients with a history of cancer, cerebrovascular disease, neuromuscular disease, stroke, inflammatory bowel disease, and trauma [3][4][5][6][7]. In cases with stenosis of the tract to the stomach, a conventional endoscope may not be able to pass through the esophagus due to a mismatch between the size of the endoscope and the diameter of the esophagus.…”

Nutritional Management for Patients with Head and Neck Cancer: The Second Step of an Italian Survey. The Opinion of Italian Otolaryngologists

“…Initial nutritional intervention often involves food enrichment and oral nutrition supplements and there are several enteral feeding strategies, such as NGT, PEG and PFG, used to improve the nutritional status of patients, but up till now there has been no consistent evidence about which method is the optimal one [30,33,37,38]. NGT and PEG are the preferred strategies for enteral support, both of them have been demonstrated to be effective in achieving nutritional intake in HNC patients undergoing radiation therapy or concurrent radiochemotherapy [37,39,40].…”

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

“…with head and neck cancer, overall complication rates from 10.9 to 42.0% have been reported for the PT technique [5] . Therefore, a technique has been introduced by Russell et al [6] to avoid the internal bumper passage and to secure the gastrostomy with 2 gastropexy sutures at the abdominal wall.…”

“…Therefore, a technique has been introduced by Russell et al [6] to avoid the internal bumper passage and to secure the gastrostomy with 2 gastropexy sutures at the abdominal wall. With this method, complications could be lowered down to 0-11% [5] . It prevents the need for laparotomy in patients in which endoscopic maneuvers have otherwise been impossible.…”