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World J Gastrointest Pathophysiol. Nov 15, 2013; 4(4): 119-125
Published online Nov 15, 2013. doi: 10.4291/wjgp.v4.i4.119
Usefulness of percutaneous endoscopic gastrostomy for supportive therapy of advanced aerodigestive cancer
Haruei Ogino, Hirotada Akiho
Haruei Ogino, Hirotada Akiho, Department of Gastroenterology, Kitakyushu Municipal Medical Center, Kitakyushu 802-0077, Japan
Author contributions: Both authors contributed extensively to this manuscript; Ogino H provided a significant editorial and literature contribution; Akiho H provided literature-related comments and review.
Correspondence to: Hirotada Akiho, MD, PhD, Department of Gastroenterology, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokura-kitaku, Kitakyushu 802-0077, Japan. akiho@med.kyushu-u.ac.jp
Telephone: +81-93-5411831 Fax: +81-93-5338693
Received: June 10, 2013
Revised: September 6, 2013
Accepted: October 16, 2013
Published online: November 15, 2013
Processing time: 158 Days and 18.6 Hours
Abstract

Aerodigestive cancer, like esophageal cancer or head and neck cancer, is well known to have a poor prognosis. It is often diagnosed in the late stages, with dysphagia being the major symptom. Insufficient nutrition and lack of stimulation of the intestinal mucosa may worsen immune compromise due to toxic side effects. A poor nutritional status is a significant prognostic factor for increased mortality. Therefore, it is most important to optimize enteral nutrition in patients with aerodigestive cancer before and during treatment, as well as during palliative treatment. Percutaneous endoscopic gastrostomy (PEG) may be useful for nutritional support. However, PEG tube placement is limited by digestive tract stenosis and is an invasive endoscopic procedure with a risk of complications. There are three PEG techniques. The pull/push and introducer methods have been established as standard techniques for PEG tube placement. The modified introducer method, namely the direct method, allows for direct placement of a larger button-bumper-type catheter device. PEG tube placement using the introducer method or the direct method may be a much safer alternative than the pull/push method. PEG may be recommended in patients with aerodigestive cancer because of the improved complication rate.

Keywords: Aerodigestive cancer; Percutaneous endoscopic gastrostomy; Direct method; Introducer method; Pull/push method; Complications

Core tip: Aerodigestive cancer is well known to have a poor prognosis and is often diagnosed in the late stages with dysphagia. Insufficient nutrition and lack of stimulation of the intestinal mucosa may worsen immune compromise. Therefore, it is most important to optimize enteral nutrition before and during treatment, as well as during palliative treatment. Percutaneous endoscopic gastrostomy (PEG) may be useful for nutritional support. PEG tube placement using the introducer method or the direct method may be a much safer alternative than the pull/push method. PEG may be recommended in patients with aerodigestive cancer because of the improved complication rate.