Introduction Maintaining oral nutrition in Head and Neck cancer patients undergoing treatment can be challenging. Therefore, patients deemed at risk of malnutrition are referred for prophylactic gastrostomy. Due to risk of tumour implantation at gastrostomy site with conventional “pull though” technique, we changed our practice to direct puncture gastrostomy in 2004, using the Fresenius ® PEXACT kit. We have previously reported series of 319 patients.1
Methods All procedures performed between January 2010 and June 2011 were identified using the endoscopy reporting system. Information regarding readmissions, complications, mortality, dietetic assessment and use of gastrostomy tube was obtained from hospital patient records.
Results 91 gastrostomies were identified in 91 patients, 49 (54%) had advanced T3/T4 cancers, 10 (11%) with T2 disease. 69 (76%) were males. Mean age = 55 years (range 32–78). Insertion was successful in all patients. All patients had prophylactic antibiotics prior to the procedure. There were no immediate procedure related complications (two immediate complications, one requiring a laparotomy, in cohort reported earlier, n=319).1 There were no deaths within 7 days of procedure. Five patients died within 30 days (5.4%). Four were due to disease progression, one patient had a cardiac arrest in the community 23 days after the procedure. There was 1 (1.09%) unplanned admission 3 weeks after the procedure with bleeding from gastrostomy site requiring laparotomy. (14 unplanned admissions 30 days post procedure in earlier cohort, n=319).1 There were no readmissions within 7 days. No cases of tumour implantation reported to date. Late displacement of gastrostomy tube (>30 days after insertion) was common (6.5%, same as in earlier cohort).1 To date we have managed to get information regarding use of gastrostomy tube in 58 out of 91 patients. Available data date so far has shown 46/58 (79.3 %) patients used their gastrostomy tube for 2 weeks or more. 12/58 (20.6%) did not require use of gastrostomy tube.
Conclusion Endoscopically assisted gastropexy and direct puncture is a safe and reliable method of gastrostomy tube placement. Overall, our complication rate has fallen, with only one delayed major procedure related complication during this period. There have been no procedure related deaths or cases of tumour implantation.
Competing interests None declared.
Reference 1. Ahmed S, Bowering K, Polavarapu N, et al. PEXACT®: analysis of 319 procedures performed at the digestive diseases unit, University Hospital Aintree. Gut 2010;59:A143. doi:10.1136/gut.2009.209049k
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