Complications Post Gastrostomy Insertion in Patients with Head and Neck Cancer: A Systematic Review

Area of Science:

• Gastroenterology
• Oncology
• Medical Devices

Background:

• Gastrostomy tube placement is common in head and neck cancer (HNC) patients for nutritional support.
• Percutaneous endoscopic gastrostomy (PEG) and radiologically inserted gastrostomy (RIG) are primary methods for gastrostomy insertion.
• Both PEG and RIG procedures carry potential risks of adverse events.

Purpose of the Study:

• To conduct an updated systematic literature review of complications associated with gastrostomy placement in HNC patients.
• To compare the safety profiles of PEG versus RIG in the HNC population.

Main Methods:

• Systematic literature search of PubMed, CINAHL, and EMBASE databases (2008-2025).
• Inclusion of empirical studies reporting gastrostomy complications in adult HNC patients.
• Classification of complications as severe or mild adverse events, with assessment of risk of bias and certainty of evidence.

Main Results:

• Analysis of 25 studies involving 4854 gastrostomy procedures (3670 PEG, 1184 RIG).
• Median procedure-related mortality and severe complications were less than 1% for both PEG and RIG.
• Severe complications requiring intervention or hospitalization occurred in approximately 1% of cases for both methods, with severe infections being less than 1% for PEG and 1% for RIG.

Conclusions:

• Gastrostomy insertion via PEG or RIG is a safe procedure for HNC patients.
• There are minimal differences in complication rates between PEG and RIG.
• The choice of insertion technique should be guided by clinical indication, healthcare provider expertise, and available hospital resources.