Complications arising from percutaneous endoscopic and radiologically inserted gastrostomies in a cohort of head and neck cancer patients
Authors: Bergin N. A. , Dale A. , Holdoway A. 
Published: May 2009

Background:  Gastrostomy placement is often required to help maintain and/or improve nutritional status in head and neck cancer patients. In this hospital trust, radiologically inserted gastrostomies (RIGs) have been the preferred route for head and neck cancer patients as a result of the physical problems associated with the percutaneous endoscopic gastrostomy (PEG) procedure in this patient group. Previous studies have revealed higher complication rates with RIGs compared to PEGs (Rustom et al., 2006, Bailey et al., 2007). This audit aimed to evaluate complications arising from PEG or RIG placement in this patient group.

Method:  Twenty‐six head and neck cancer patients (19 male, seven female), who had either a PEG (n = 5) or RIG (n = 21) inserted between January 2006 to December 2007, were retrospectively audited. The methodology was based on a similar audit carried out by Bailey et al. (2007). Medical, nursing and dietetic documentation were reviewed for any complications as shown in Table 1.

 Complications that occurred within the first week of PEG and RIG replacement

PEG (n = 5)
RIG (n = 21)

Major complications

Perforation, tube dislodgment, peritonitis
0
3 (14%)

Minor complications

Minor infection
0
1

Inflammation
0
0

Trapped wind
1
1

Other*
2
4

Total minor complication
3 (60%)
6 (29%)

*Abdominal discomfort, abdominal pain, abdominal tenderness, abdominal bloating, leakage around RIG/PEG site, pyrexia of unknown cause.

Results:  Reasons for inserting a gastrostomy were reduced nutritional intake arising from anticipated dysphagia pre/with treatment (65%), present severe dysphagia (15%), side effects related to treatment (8%), and not documented (12%). Reasons for inserting a RIG instead of a PEG were anticipated failure of PEG (76%), contraindication for PEG (10%), and not documented (14%). Complications that occurred in the PEG and RIG group within the first week of placement are detailed in the Table 1.

Discussion:  There were no major complications in the PEG group compared to 14% in the RIG group. Minor complications occurred in 60% of the PEG group and 29% in the RIG group. These data can be compared to that of Bailey et al. (2007) who reported a major complication rate of 16% in RIGs versus 2% in PEGs. The higher major complications in the RIG group may reflect the fact that, in our unit, RIGs are inserted in those individuals with more advanced head and neck cancer, whose nutritional status is expected to be compromised.

Conclusions:  Because the two groups are not evenly matched and the sample size is small, it is difficult to draw any absolute conclusions. However, all patients are closely monitored for any complications post‐gastrostomy placement.

References Bailey, D., Baldwin, D. & Caldera, S. (2007) Head and neck cancer gastrostomy audit. Cancer Intelligence Service, South West Public Health Observatory, Taunton, Devon, UK.

Rustom, I.K., Jebreel, A., Tayyab, M., England, R.J. & Stafford, N.D. (2006) Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer. J. Laryngol. Otol.120, 463–466.