Usage of prophylactic radiologically inserted gastrostomy in head and neck cancer patients.

To assess outcomes and usage rate of prophylactic radiologically inserted gastrostomy (RIG) in head and neck cancer (HNC) patients. Outcome data of all HNC patients who underwent prophylactic RIG over a 22-month period (November 2007 to September 2009) in a tertiary referral centre were collected retrospectively. Thirty-day mortality, major and minor complication rates, and subsequent usage of the RIG were analysed. Fifty-one HNC patients underwent prophylactic RIG. Three minor and no major immediate complications were identified. Sixteen minor and three major complications at 30-days were identified. Three (5.9%) major complications were identified. There was one death due to disease progression and not RIG insertion. The RIG was not used in 17.7% of patients post-procedure. Prophylactic RIG in HNC patients has a comparable mortality rate to RIG insertion in HNC patients with mixed indications. However, the number of cases where the gastrostomy is not used raises important concerns and warrants further investigation.

Mallinson PI ，Tun JK ，Byass OR ，Cast JE ... -  《-》

Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates.

Patients with head and neck cancer who have resection, radiotherapy, chemoradiotherapy, or a combination of these require nutritional support to be implemented before treatment, and this may involve insertion of a prophylactic gastrostomy feeding tube. The aim of this study was to compare the use and complication rates of percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) in these patients at a tertiary referral centre. We retrospectively reviewed gastrostomy data forms completed by nutritional support nursing staff over a recent 34-month period, which included information on method of insertion, 30-day postoperative serious and minor complications, and mortality. A total of 110 patients had prophylactic insertion of a gastrostomy (21 PEG, 89 RIG) over the study period. In the first 12 months 13 (31%) PEG feeding tubes were placed but in the last 12 months none were inserted using an endoscopic approach. Serious complications occurred with 2 (10%) PEG and 12 (13%) RIG; the most common cause was accidental removal of the tube (n=13, 12%). Minor complications of peristomal infection, leakage, or blockage of the tube occurred in 6 (5%) gastrostomies. No patients died during the study period. In recent years, and in the absence of recommended guidelines, there has been an increase in the elective insertion of RIG in patients with head and neck cancer. Serious complications for both methods of insertion in this study are comparable with similar reports. However, with RIG there is a high rate of tubes becoming dislodged with the potential for serious consequences. The most appropriate method to insert a gastrostomy tube in patients with head and neck cancer remains unclear.

McAllister P ，MacIver C ，Wales C ，McMahon J ，Devine JC ，McHattie G ，Makubate B ... -  《-》

Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients.

Rustom IK ，Jebreel A ，Tayyab M ，England RJ ，Stafford ND ... -  《JOURNAL OF LARYNGOLOGY AND OTOLOGY》

Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): A comparison of outcomes at an Australian teaching hospital.

Gastrostomy tubes for enteral nutrition are most commonly inserted via percutaneous endoscopic gastrostomy (PEG) or radiologically inserted gastrostomy (RIG) techniques. The current study aimed to compare clinical outcomes and complication rates in patients who underwent PEG and RIG procedures at a tertiary teaching hospital in Australia. A retrospective review was conducted on patients who underwent PEG or RIG tube insertion between February 2013 and February 2015 at Flinders Medical Centre, Australia. The primary outcome studied was the tube dislodgement rate. Secondary outcomes measured included hospital length of stay, 30 day and 1 year mortality and peri- and post-procedural complications such as hypoxia, bleeding, stoma site infection and haematoma. Baseline comparisons were conducted using the Mann-Whitney test and chi square test. 137 patients (PEG = 85, RIG = 52) underwent gastrostomy tube insertion. Indications for insertion were head and neck cancer (PEG = 30, RIG = 21), stroke (PEG = 27, RIG = 11), post-trauma (PEG = 6, RIG = 3) and neuromuscular pathologies (PEG = 9, RIG = 0). There was a significantly higher tube dislodgement rate in RIG (26.5%) compared to PEG (2.4%), p < 0.001. The 1-year mortality was also significantly higher after RIG (46.2%) compared to the PEG group (16.7%), p < 0.05. No differences were seen in other peri- and post-procedural complications. Although both PEG and RIG insertion techniques compare favourably in terms of the majority of peri and post procedural complications, the rates of tube dislodgement were significantly higher in the RIG group. The higher mortality rate at 1 year after RIG placement may be related to patient selection particularly as no differences were seen at 30 days.

Vidhya C ，Phoebe D ，Dhina C ，Jayne S ，Robert F ... -  《Clinical Nutrition ESPEN》

Percutaneous radiological gastrostomy in patients with head and neck cancer.

To evaluate the results of percutaneous radiological gastrostomy in patients with head and neck cancer. This was a retrospective study design. One hundred and eighteen patients with head and neck cancer were referred 130 times for gastrostomy tube placement between 1 April 1993 and 17 August 1998. Mean age was 60 years. All data were analysed by using the following parameters: success rate, complications and mortality. Complications were divided into major, minor (complication that needed only conservative treatment) and tube-related. The success rate of percutaneous radiological gastrostomy was 97%. Major complications occurred in 6% of patients after gastrostomy tube placement. Minor complications occurred in 15% of patients. There was one tube-related complication. Procedure-related mortality occurred in one patient. The results of this study show no difference from those known from the literature for the percutaneous method and confirm that radiological gastrostomy has significantly lower rates of major complications than other methods of gastrostomy placement. Percutaneous radiological gastrostomy tube placement is, in our opinion, an effective and reliable method for placing a feeding tube in patients with head and neck cancer.

Deurloo EE ，Schultze Kool LJ ，Kröger R ，van Coevorden F ，Balm AJ ... -  《-》