[Basic principles of enteral nutrition, tube techniques, percutaneous endoscopic gastrostomy]

Cachexia of malignancy is a heterogenous and dynamic phenomenon. Thirty to fifty percent of all oncologic patients suffer from malnutrition. Patients with ENT carcinomas, from the clinical view-point, are clearly high-risk patients. Essentially, malnutrition in ENT carcinoma patients is attributable to reduced or even insufficient energy supply and intake of nutrients as a result of pain experienced in swallowing and constrictions of the upper swallowing tract. Malnutrition has turned out to be a factor entailing an unfavourable prognosis and, frequently, limiting a therapy. In a survey conducted by the Endoscopy Working Group of the German Society for Otorhinolaryngology, Head and Throat Surgery, 70% of the university ENT hospitals confirmed that their patients experienced a clinically relevant weight loss in the range from 3 to 10 kg during oncologic causal treatment. Tube feeding with liquid formula diets is the most efficient, least-risk approach to long term use, and should already be adopted prior to therapy irrespective of scheduled oncologic causal therapy. The feeding tube placed by percutaneous endoscopically controlled gastrostomy is increasingly becoming an alternative to a nasogastric tube. Two basic PEG techniques have been employed: 1. the transoral pull technique and 2. direct puncture. In direct puncture, as distinct from the pull technique, iatrogenic dispersal of tumour cells from the primary location of the tumour with subsequent implantation in the gastric or abdominal wall is definitely ruled out. In the ENT Clinic of Magdeburg University, we decided to adopt direct puncture and, since 1991, this technique has been used in interdisciplinary co-operation with the Magdeburg University Clinic of Gastroenterology and successfully employed in 660 patients with advanced carcinomas of the upper swallowing tract. Severe PEG-induced abdominal complications were extremely rare, observed in as little as 0.5% of the cases. For enteral feeding through PEG which maintained or even improved the nutritional status, good compliance was noted in 83% of the patients. Prior to PEG and oncologic causal therapy, 36% of the patients showed malnutrition (BMI < 20 kg/m2). At the stage of anamnesis half of the patients indicated that, for the past six months prior to diagnosis of the tumour, they had experienced a weight loss of more than 10% of the calculated ideal body weight. Prior to therapy, 97% of the patients complained of dysphagia-induced reduced or impaired food intake. The various PEG tube techniques, along with their pros and cons, as well as nutritional aspects in oncology are presented for the Magdeburg patients and discussed.