Percutaneous endoscopic gastrostomy for long term enteral nutrition.
BACKGROUND
Percutaneous endoscopic gastrostomy for long term enteral nutrition is often indicated in patients with head, neck and oesophageal cancer but despite its growing popularity elsewhere, it is not widely used in India.


METHODS
Between March 1990 and July 1991, we performed percutaneous endoscopic gastrostomy in 54 patients. The primary sites of tumour were the hypopharynx (11), oral cavity (7), tongue (7), cricopharynx (7), oesophagus (16) and other sites (6). The indications were difficulty in swallowing following treatment (22), preoperative nutritional support (7) and terminal care (21). In 49 patients, it was performed by the 'pull' technique in the endoscopy room under local anaesthesia and mild sedation. Indigenously prepared tubes and blenderised foods were used. Fifteen patients underwent dilatation of the tumour prior to the gastrostomy.


RESULTS
The procedure was successful in 50 (93%) patients. Three failures were caused by obstructing tumours and one by a previous gastric resection. Feeding was started 18 to 24 hours after the procedure in 48 patients. No major complications occurred but minor complications were seen in 11 (22%) patients. Fourteen patients had their gastrostomy tube removed after 2 to 6 months of use while 15 patients undergoing therapy or with persistent dysphagia were on gastrostomy feeds for 1 to 6 months. Of the 21 terminally ill patients, 8 died, 6 were lost to follow up and 7 were on feeds for 1 to 6 months.


CONCLUSIONS
Percutaneous endoscopic gastrostomy is a simple, safe and effective method for long term enteral feeding. Indigenous tubes and home made blenderised foods are adequate substitutes for the more expensive commercial kits and enteral formulations.
Mohandas
K M
KM
Department of Gastroenterology, Tata Memorial Hospital, Parel, Bombay, Maharashtra, India.
Dave
U R
UR
Santhi Swaroop
V
V
Desai
D C
DC
Dhir
V
V
Pradhan
S A
SA
Bathena
H M
HM
Kavarana
N M
NM
D000293:Adolescent; D000328:Adult; D000368:Aged; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects / Q000379:methods; D004750:Enteral Nutrition / Q000295:instrumentation*; D004938:Esophageal Neoplasms / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged