Transnasal PEG tube placement in patients with head and neck cancer.

BACKGROUND

Head and neck cancer (H&NCa) patients have an increased risk of malnutrition and dysphagia because of their malignancy and the adverse events of therapy. Most of these patients require gastrostomies. Four percent to 7% of H&NCa patients are unable to undergo per oral percutaneous gastrostomies. Transnasal endoscopy is an option for gastrostomy placement in selected patients.

OBJECTIVE

Clinical, epidemiologic characteristics and outcomes of transnasal PEG (t-PEG) placement.

DESIGN

Retrospective analysis.

SETTING

Tertiary care hospital, The University of Texas MD Anderson Cancer Center.

PATIENTS

All patients who underwent t-PEG placement.

MAIN OUTCOME MEASUREMENTS

Epidemiology, adverse events, and outcomes of t-PEG placement.

RESULTS

Sixteen patients underwent t-PEG placement from January 2010 to May 2013. All patients had H&NCa and 56.3% had metastasis. Indications for the transnasal approach were airway compromise, malignant oropharyngeal obstruction, and trismus, among others. All procedures were successful using a 20F gastrostomy tube, push technique, anesthesiologist-guided propofol sedation, and/or nasotracheal intubation. Of all patients, 68.8% were white and 68.8% were men. Mean age was 54 years, and mean body mass index was 20.87. Two patients had a total of 2 adverse events: poor wound healing and wound site infection. Of all patients, 18.75% had leukopenia, 6.25% neutropenia, and 50% lymphopenia. Mean white blood cell count, absolute neutrophil count, and absolute lymphocyte count were 8.6 × 10(9)/L, 6.57 × 10(9)/L, and .93 × 10(9)/L, respectively. Eleven patients were alive, 2 were lost to follow-up, and 3 had died at the time of review.

LIMITATIONS

Retrospective analysis, small cohort, patient selection bias.

CONCLUSION

t-PEG placement is a viable and safe option for H&NCa patients when the standard endoscopic approach is not feasible.