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

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 pos...

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Main Authors: Louise Deluiz Verdolin Di Palma, Gustavo Francisco de Souza e Mello, Cindy Lis Granados, Ricardo Dardengo Glória, Caroline Sauter Dalbem, Rolantre Lopes da Cruz, Ana Carolina Maron Ayres, Renata Sofia Camara Lisboa, Alexandre Dias Pelosi, Maria Aparecida Ferreira, Gilberto Reynaldo Mansur, Simone Guaraldi da Silva, Theresa Christina Damian Ribeiro, Fernando Luiz Dias
Format: Article
Language:English
Published: Georg Thieme Verlag KG 2017-07-01
Series:Endoscopy International Open
Online Access:http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-106581
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author Louise Deluiz Verdolin Di Palma
Gustavo Francisco de Souza e Mello
Cindy Lis Granados
Ricardo Dardengo Glória
Caroline Sauter Dalbem
Rolantre Lopes da Cruz
Ana Carolina Maron Ayres
Renata Sofia Camara Lisboa
Alexandre Dias Pelosi
Maria Aparecida Ferreira
Gilberto Reynaldo Mansur
Simone Guaraldi da Silva
Theresa Christina Damian Ribeiro
Fernando Luiz Dias
author_facet Louise Deluiz Verdolin Di Palma
Gustavo Francisco de Souza e Mello
Cindy Lis Granados
Ricardo Dardengo Glória
Caroline Sauter Dalbem
Rolantre Lopes da Cruz
Ana Carolina Maron Ayres
Renata Sofia Camara Lisboa
Alexandre Dias Pelosi
Maria Aparecida Ferreira
Gilberto Reynaldo Mansur
Simone Guaraldi da Silva
Theresa Christina Damian Ribeiro
Fernando Luiz Dias
author_sort Louise Deluiz Verdolin Di Palma
collection DOAJ
description 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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spelling doaj.art-55f056cb2955406480dad536546435682022-12-21T19:42:10ZengGeorg Thieme Verlag KGEndoscopy International Open2364-37222196-97362017-07-010507E630E63410.1055/s-0043-106581Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patientsLouise Deluiz Verdolin Di Palma0Gustavo Francisco de Souza e Mello1Cindy Lis Granados2Ricardo Dardengo Glória3Caroline Sauter Dalbem4Rolantre Lopes da Cruz5Ana Carolina Maron Ayres6Renata Sofia Camara Lisboa7Alexandre Dias Pelosi8Maria Aparecida Ferreira9Gilberto Reynaldo Mansur10Simone Guaraldi da Silva11Theresa Christina Damian Ribeiro12Fernando Luiz Dias13Department of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilDepartment of Digestive Endoscopy, Cancer Hospital I, Brazilian National Cancer Institute, Rio de Janeiro, BrazilBackground 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.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-106581
spellingShingle Louise Deluiz Verdolin Di Palma
Gustavo Francisco de Souza e Mello
Cindy Lis Granados
Ricardo Dardengo Glória
Caroline Sauter Dalbem
Rolantre Lopes da Cruz
Ana Carolina Maron Ayres
Renata Sofia Camara Lisboa
Alexandre Dias Pelosi
Maria Aparecida Ferreira
Gilberto Reynaldo Mansur
Simone Guaraldi da Silva
Theresa Christina Damian Ribeiro
Fernando Luiz Dias
Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
Endoscopy International Open
title Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
title_full Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
title_fullStr Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
title_full_unstemmed Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
title_short Pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
title_sort pharyngocutaneous fistula as an alternative access route for inserting a percutaneous endoscopic gastrostomy tube in head and neck cancer patients
url http://www.thieme-connect.de/DOI/DOI?10.1055/s-0043-106581
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