title: The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) tubes are often placed in head and neck cancer patients to provide nutritional support, but studies have found the complication rates to be higher than other subsets of patients who undergo PEG placement. Complication rates as high as 50% have been reported, with the bulk of these complications being PEG site issues (i.e., cellulitis, abscess, fascitis, and tumor implantation). Because the pull technique has been the primary technique used, the theory is that the transoral tube passage is the source of the complications in these patients. Alternatively, the introducer technique uses a transabdominal approach to place the device, avoiding any tube contamination by upper aerodigestive organisms or tumor cells. At our institution, this technique has been used exclusively for head and neck cancer patients and this article reports our experience.
  
  
  METHODS
  One hundred forty-nine head and neck cancer patients who had a prophylactic PEG tube placed were reviewed from January 1, 1999 to December 31, 2003. The rates of placement success, morbidity, and complications were determined.
  
  
  RESULTS
  Successful placement was achieved in 148 (99%) patients without any PEG-related deaths. Overall, 17 complications (11%) occurred, with only one major complication (0.7%) identified. PEG site infections were uncommon with only five cases (3.4%) and all were mild cellulitis.
  
  
  CONCLUSIONS
  The introducer technique is the safest method for PEG tube placement in head and neck cancer patients. The overall rate of complications is low and PEG site infectious complications are rare. The introducer technique should be the method of choice for PEG tubes in head and neck cancer patients.
authors.affiliation: Department of Surgery, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Foster
authors.forename: Peter
authors.initials: P
authors.lastname: Filocamo
authors.forename: Hector
authors.initials: H
authors.lastname: Nava
authors.forename: Michael
authors.initials: M
authors.lastname: Schiff
authors.forename: Wesley
authors.initials: W
authors.lastname: Hicks
authors.forename: Nestor
authors.initials: N
authors.lastname: Rigual
authors.forename: Judy
authors.initials: J
authors.lastname: Smith
authors.forename: Thom
authors.initials: T
authors.lastname: Loree
authors.forename: John F
authors.initials: JF
authors.lastname: Gibbs
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D044342:Malnutrition / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged