Transnasal PEG tube placement in patients with head and neck cancer

BackgroundHead 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.ObjectiveClinical, epidemiologic characteristics and outcomes of transnasal PEG (t-PEG) placement.DesignRetrospective analysis.SettingTertiary care hospital, The University of Texas MD Anderson Cancer Center.PatientsAll patients who underwent t-PEG placement.Main Outcome MeasurementsEpidemiology, adverse events, and outcomes of t-PEG placement.ResultsSixteen 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 × 109/L, 6.57 × 109/L, and .93 × 109/L, respectively. Eleven patients were alive, 2 were lost to follow-up, and 3 had died at the time of review.LimitationsRetrospective analysis, small cohort, patient selection bias.Conclusiont-PEG placement is a viable and safe option for H&NCa patients when the standard endoscopic approach is not feasible.