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Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients - PubMed

Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients

Louise Deluiz Verdolin Di Palma et al. Endosc Int Open. 2017 Jul.

Abstract

Background and study aims: Performing a percutaneous endoscopic gastrostomy (PEG) in head and neck cancer (HNC) patients can be challenging because of the presence of trismus, pharyngeal obstruction by tumor, and pharyngoesophageal strictures or fistula. Pharyngocutaneous fistula (PCF) is a major postoperative concern in patients submitted to total laryngectomy (TL). In the medical literature to date, the cervical fistula has been used as an access to PEG in only four reports. The aim of this study was to evaluate the safety of cervical fistula for insertion of a PEG tube.

Patients and methods: Retrospective study at a single tertiary referral center, regarding the technical feasibility, safety and outcomes of a PEG tube introduced by a cervical fistula in HNC patients with obstructive lesions of the oropharynx.

Results: The procedure was technically successful in all 21 patients. A PEG tube was used for a minimum of 1 month and a maximum of 120 months. Twelve patients died while using the PEG tube, 8 had it taken out because it was no longer needed, and only 1 had the tube still in use. Adverse events occurred in 8 patients: granuloma (19 %), dermatitis (9.5 %), accidental late removal of the tube (9.5 %), periprocedural gastric wall hematoma (9.5 %), peristomal wound infection (4.7 %), buried bumper syndrome (4.7 %), and traumatic gastric ulcer (4.7 %).

Conclusion: A postoperative cervical fistula can successfully work as a reliable and safe access for a PEG tube procedure in HNC patients, avoiding unnecessary surgery and reducing costs.

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Conflict of interest statement

Competing interests None

Figures

Fig. 1
Fig. 1

Alternative access route for inserting a PEG tube using the ‘‘pull’’ method (Gauderer-Ponsky technique) a External aspect of the anterior cervical wall defect. A nasoenteric tube is seen across the exposed posterior wall of the pharyngeal region. A tracheostomy tube is in place. b Dilation of the narrowed and fibrotic esophageal opening with a Savary bougie. c Endoscope introduced in the esophagus. d The guide-wire is pulled out of the esophagus and connected to the PEG tube. e PEG tube insertion through the cervical opening. f PEG tube internal bumper advancement.

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