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PTU-099 A Large Prospective Audit of Morbidity and Mortality in Patients with Feeding Gastrostomies Placed for Head and Neck Cancer
  1. K Keshk,
  2. S Lewis,
  3. N Pitts
  1. Gastroenterology, Derriford Hospital, Plymouth, UK


Introduction Feeding patients undergoing radical treatment for head and neck cancer via a percutaneous endoscopically or radiologically placed/inserted gastrostomy (PEG, RIG) is common practice. PEG/RIG insertion is not entirely safe and complications may occur with long-term usage. We did a prospective audit of PEG/RIG related complications in patients having them placed prior to surgery for head and neck cancer.

Methods Community dietitians reviewed all patients with a gastrostomy placed prior to surgery or radiotherapy for head and neck cancer. They prospectively recorded morbidity and mortality between 2008–2014. In addition hospital databases and case notes were examined. Recorded morbidity included insertion site infection, leakage, over granulation, haemorrhage and buried bumper.

Results In the 206 patients there was one death within 30 days from placement, no deaths attributable to gastrostomy placement. One patient underwent a laparotomy for peritonitis. 95 minor complications occurred in 72 (35%) patients or 1:887 days of having a gastrostomy. The commonest complication was peristomal site infection occurring in 55 (27%) patients or 1:1531 days of having a gastrostomy, all of which settled with antibiotics. There was no buried bumpers or tumour implantation at the insertion site reported in the study. There was no procedure related 30 day mortality.

Abstract PTU-099 Table 1

Complications of gastrostomies

Conclusion We have shown a low rate of major complications (0.5%) and a relatively high minor complications rate (35%) of PEGs and RIGs in patients with head and neck cancer. Wound infection can be reduced by careful sterile technique, preoperative antibiotics, a 1 cm abdominal incision and avoiding tightness of the crossbar. We conclude that the use of PEG tubes is a safe method of delivering non-oral nutritional support for patients undergoing treatment for head and neck cancer.

References 1 Gauderer MW, Ponsky JL, Izant RJ, Jr. Gastrostomy without laparotomy: A percutaneous endoscopic technique. J Pediatr Surg 1980;15:872–5.

2 Mansoor H, Masood MA, Yusuf MA. Complications of percutaneous endoscopic gastrostomy Tube insertion in Cancer patients: A retrospective study. J Gastrintest Cane 2014;45:452–459.

3 Burney RE, Bryner BS. Safety and long-term outcomes of percutaneous endoscopic gastrostomy in patients with head and neck cancer. Surg Endosc 2015;29(12):3685–9.

4 Hunter JG, Lauretano L, Shellito PC. Percutaneous endoscopic gastrostomy in head and neck Cancer patients. Ann Surg 1989;210:42–46.

Disclosure of Interest None Declared

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