Percutaneous endoscopic gastrostomy in head and neck cancer patients

Unique problems accompany percutaneous endoscopic gastrostomy (PEG) in head and neck cancer patients. This study analyzed the experience of one surgeon (P.S.) performing PEG in 50 patients with advanced oropharyngeal cancer. The records of 54 such patients consecutively referred for PEG at the Massachusetts General Hospital were reviewed. A pull-through PEG technique was used. The procedure was successful in 50 patients (success rate, 93%). Failures were caused by esophageal stricture, respiratory distress, and hiatus hernia. The two patients with insurmountable esophageal stricture had piriform sinus tumors. Cancer in this location and pharyngoesophageal strictures were predictive of PEG failure. A single death, 21 days after endoscopy, was caused by pneumonia. The only major complications were two transient respiratory arrests. Neither patient had a tracheostomy in place, and both had unresected cancer present. Minor complications were transient gastroparesis, pneumonia, unexplained fever, and a broken traction suture. There were no wound or intraabdominal infections and no episodes of bleeding. While PEG was successful in 93% of these difficult patients, with few complications, results could be improved by tracheostomy or resection performed before PEG in patients with tumors near the airway and dilatation of troublesome esophageal strictures under endoscopic view before PEG.