title: The prospective experience of a maxillofacial surgeon with the percutaneous endoscopic gastrostomy technique.
abstract: Insertion of a percutaneous endoscopic gastrostomy (PEG) was attempted on 225 occasions, mainly for oral malignancy. Seventy-five percent (169/225) were inserted at the time of definitive surgery. There were significant incidental findings during 5% (11/225). The rate of successful insertion was 97% (219/225). The incidence of minor complications was 12% (26/225) and major complications 3% (7/225). There was no procedure-related mortality. The 30-day mortality rate, including those with terminal malignant disease, was 6% (14/225). An increased risk of death was associated with age of 65 years and over (P=0.004). The median PEG duration was 337 (SE 31) days. Duration was significantly longer for stage T3-4 tumours (P=0.028), N1 or greater neck disease (P=0.034), following surgery with radiotherapy when compared to surgery alone (P<0.001), particularly glossectomy (P=0.038) and maxillectomy procedures (P=0.003), after two separate surgical procedures and radiotherapy (P=0.046) and following a composite bone resection (P=0.031), or radiotherapy alone when compared to surgery alone (P=0.003). There was no relationship to the type of flap used for reconstruction. Four patients have a long-term PEG. Only two patients did not use the PEG. The early insertion of a PEG in all patients undergoing free or pedicled flap reconstruction appears to be appropriate. The PEG procedure may be safely performed by an appropriately trained maxillofacial surgeon.
authors.affiliation: University Hospitals of Leicester, Leicester, UK. chrisavery@doctors.org.uk
authors.forename: C
authors.initials: C
authors.lastname: Avery
authors.forename: S
authors.initials: S
authors.lastname: Shenoy
authors.forename: S
authors.initials: S
authors.lastname: Shetty
authors.forename: C
authors.initials: C
authors.lastname: Siegmund
authors.forename: I
authors.initials: I
authors.lastname: Mazhar
authors.forename: N
authors.initials: N
authors.lastname: Taub
mesh_terms: D000367:Age Factors; D000368:Aged; D002423:Cause of Death; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods*; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005927:Glossectomy; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008437:Maxilla / Q000601:surgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000601:surgery*; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D019651:Plastic Surgery Procedures; D012307:Risk Factors; D013515:Surgery, Oral; D013524:Surgical Flaps; D013997:Time Factors; D016896:Treatment Outcome