Prophylactic Percutaneous Endoscopic Gastrostomy (PEG) - The Importance of Nutritonal Support in Patients with Head and Neck Cancers (HNCs) or Neurogenic Dysphagia (ND)
D. Cristian, A. Poalelungi, A. Anghel, T. Burcoş, R. Grigore, S. Berteşteanu, G. Richiteanu, F. GramaOriginal article, no. 2, 2015
Backround: We evaluated the effectiveness and safety ofprophylactic PEG performed for the enteral nutrition supportduring the oncological treatment of patients with HNCsand as a part of the management of neurological patientsexperiencing neurogenic dysphagia.Methods: In 2013 we followed up on a group of 23 HNCpatients subjected to prophylactic PEG. We assessed theduration of the procedure, intraprocedural incidents and theircauses, time to tube-refeeding and discharge after intervention,postinterventional analgesia, early and late complications,toleration, costs and postoperative course of these patientsafter radical surgery maintaining PEG in place. In parallel wefollowed up on a group of 10 neurological patients who haveundergone a PEG placement to improve the nutrional statusand to prevent recurrent chest infections due to ND relatedsilent aspiration.Results: The procedures were performed under sedation withMidazolam and the mean duration was about 7 minutes.Postoperative analgesia was minimal. Refeeding through thetube was initiated 2-4h hours later and the patients weredischarged 12-24h after the procedure. Early complicationswere not observed and later we noted 2 cases of peristomalinfections, succesfully managed conservatively. After oncologicsurgery we noted 2 (8.69%) pharyngocutaneous fistulas.Conservative care obliterated the fistulas at 6 weeks, maintainingthe feeding tube in place. We also compared the resultswith a group of 27 patients fed through the naso-gastric tubeand a group of 20 cases with open gastrotomy-tube prophylacticallyinserted. The 10 neurological patients had varied conditionsbut degenerative diseases like motor neuron disease (3cases â€" 30%) and multiple sclerosis (2 cases -20%) took thelead. We encountered one case of peristomal infection and onecase of tube blockage resolved by replacement. We evaluatedthe nutritional status by controling the weight of these patientsbefore and after PEG placement. A mean weight gain of 3.1 kg(range 1.2 â€" 7) was documented.Conclusions: PEG is a simple minimmaly invasive procedureperformed safely under sedation. It takes a very short time andis virtually free of major complications. The requirements ofanalgesics are minimal. The refeeding is started early and thetube is well tolerated by the patient. PEG has an importantrole in the conservative healing of pharyngocutaneous fistula.PEG is the procedure of choice for the neurological patients.It prevents weight loss and aspiration pneumonia in pacientswith neurogenic dysphagia with a low rate of complications.
