Percutaneous Endoscopic Gastrostomy and Jejunostomy for Long-Term Feeding in Patients with Cancer of the Head and Neck

Abstract

Enteral feeding is often required in patients with cancer of the head and neck. Percutaneous endoscopic gastrostomies (PEGs) and Jejunostomies (PEJs) can facilitate enteral feeding in patients who require this treatment. The endoscopic technique allows for the placement of feeding gastrostomies and Jejunostomies without a surgical procedure and eliminates the need for nasal tubes for long-term enteral feeding. Forty-two patients with head and neck tumors were referred for placement of PEGs because of severe dysphagia induced by tumors, surgery, radiation, or chemotherapy. The procedure was performed in the gastroenterology suite. Patients were sedated with intravenous meperidine and diazepam, and local anesthetic with lidocaine was applied to the area of incision. Average procedure time was approximately 20 minutes. The procedure was successful in 39 patients in whom tubes were placed ranging in diameter from 15F to 22F. PEGs were placed in 36 patients with intact stomachs and PEJs in three patients with previous gastrectomies. The remaining three procedures were unsuccessful because of technical reasons. There were three localized skin infections, and all responded to antibiotic therapy. Neither peritonitis nor any other immediate complication occurred. In 16 nonhospitalized patients, the procedure was performed on an outpatient basis. After a mean followup of 4.5 ± 6 months of enteral feeding in the home, there was only one case of aspiration and subsequent pneumonia, and this case responded to antibiotics. No other long-term complications were noted. Thus feeding gastrostomies and Jejunostomies can be placed safely and easily in patients with cancers of the head and neck by endoscopic methods without abdominal surgery. These tubes can be used for enteral feeding and eliminate the need for nasogastric tubes. They are better tolerated, are of a wider diameter, and have a reduced risk for migration, clogging, and aspiration-related complications.

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References

Bloch

Shike

. Nutrition and cancer: Head and neck cancer. In: Jeejeebhay

, ed. Current therapy in nutrition. Philadelphia: BC Decker, 1988; 345–50.

Mantravadi

RVP

Skolnik

Applebaum

. Complication of post-operative and pre-operative radiation therapy in head and neck cancers. Arch Otolaryngol 1981; 107: 690–3.

Donaldson

. Nutritional consequences of radiotherapy. Cancer Res 1977; 37: 2407–13.

Coleman

. Complications of head and neck surgery. Surg Clin North Am 1986; 66: 149–82.

MacCarthy-Leventhal

. Post-radiation mouth blindness. Lancet 1959; 2: 1138–9.

Wasiljew

Ujiki

Beai

. Feeding gastrostomy: Complications and mortality. Am J Surg 1982; 143: 194–5.

Wilkinson

Pickelman

. Feeding gastrostomy: A reappraisal. Am Surg 1982; 48: 273–5.

Heimbach

. Surgical feeding procedures in patients with neurological disorders. Ann Surg 1970; 172: 311–4.

Ponsky

Gauderer

MWL

Stellato

. Percutaneous endoscopic gastrostomy. Arch Surg 1983; 118: 913–4.

10.

Larson

Fleming

Ott

Schroederer

. Percutaneous endoscopic gastrostomy: A simplified access for enteral nutrition. Mayo Clin Proc 1983; 58: 103–7.

11.

Shike

Schroy

Morse

Ritchie

. Percutaneous endoscopic jejunostomy in cancer patients with previous gastric resection. Gastrointest Endosc 1987; 33: 372–4.

12.

Brennan

. Total parenteral nutrition in the cancer patient. N Engl J Med 1981; 305: 373–7.

13.

Copeland

Daly

Dudnick

. Nutritional concepts in the treatment of head and neck malignancies. Head Neck Surg 1979; 1: 350–63.

14.

Bonanni

Perazzi

. Variations of taste sensitivity in patients subjected to high-energy irradiation for tumors of the oral cavity. Nunt Radiol 1965; 31: 383–97.

15.

DeWys

Walters

. Abnormalities in taste sensation in cancer patients. Cancer 1975; 36: 1888–96.

16.

Brown

Dreizen

Rider

Johnston

. The effect of radiation-induced xerostomia on saliva and serum lysozyme and immunoglobulin levels. Oral Surg Oral Med Oral Pathol 1976; 41: 83–92.

17.

Ouhuma

Holland

. Nutritional consequences of cancer chemotherapy and immunotherapy. Cancer Res 1977; 37: 2395–406.