Musumba Crispin O, Hsu Julia, Ahlenstiel Golo, Tutticci Nicholas J, Nanda Kavinderjit S, van der Poorten David, Lee Eric Y, Kwan Vu
Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia.
Gastroenterol Res Pract. 2015;2015:612610. doi: 10.1155/2015/612610. Epub 2015 Apr 21.
Background. Percutaneous endoscopic gastrostomy (PEG) placement using the "pull" technique is commonly utilized for providing nutritional support in head and neck cancer (HNC) patients, but it may be complicated by peristomal metastasis in up to 3% of patients. Overtube-assisted PEG placement might reduce this risk. However, this technique has not been systemically studied for this purpose to date. Methods. Retrospective analysis of consecutive patients with HNC who underwent overtube-assisted PEG placement at Westmead Hospital, Australia, between June 2011 and December 2013. Data were extracted from patients' endoscopy reports and case notes. We present our technique for PEG insertion and discuss the feasibility and safety of this method. Results. In all 53 patients studied, the PEG tubes were successfully placed using 25 cm long flexible overtubes, in 89% prophylactically (before commencing curative chemoradiotherapy), and in 11% reactively (for treatment of tumor related dysphagia or weight loss). During a median follow-up period of 16 months, 3 (5.7%) patients developed peristomal infection and 3 others developed self-limiting peristomal pain. There were no cases of overtube-related adverse events or overt cutaneous metastases observed. Conclusions. Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.
背景。采用“牵拉”技术经皮内镜下胃造口术（PEG）常用于为头颈部癌（HNC）患者提供营养支持，但高达3%的患者可能会并发造口周围转移。外套管辅助PEG置管可能会降低这种风险。然而，迄今为止尚未针对此目的对该技术进行系统研究。方法。对2011年6月至2013年12月期间在澳大利亚韦斯特米德医院接受外套管辅助PEG置管的连续HNC患者进行回顾性分析。数据从患者的内镜检查报告和病历中提取。我们介绍了PEG置入技术，并讨论了该方法的可行性和安全性。结果。在所有53例研究患者中，使用25厘米长的柔性外套管成功置入PEG管，其中89%为预防性置管（在开始根治性放化疗之前），11%为反应性置管（用于治疗肿瘤相关吞咽困难或体重减轻）。在中位随访期16个月期间，3例（5.7%）患者发生造口周围感染，另外3例出现自限性造口周围疼痛。未观察到与外套管相关的不良事件或明显的皮肤转移病例。结论。外套管辅助PEG置管在HNC患者中是一种可行、简单且安全的技术，可能对预防皮肤转移有效。
