title: An audit of percutaneous endoscopic gastrostomy insertion in patients undergoing treatment for head and neck cancer: reducing the incidence of peri-operative airway events by the introduction of a tumour assessment protocol.
abstract: BACKGROUND
  The presence of a malignancy of the upper aerodigestive tract introduces the potential for iatrogenic complications additional to those usually associated with percutaneous endoscopic gastrostomy. Specifically, seeding of tumour from the upper aerodigestive tract creating abdominal wall metastases, and airway obstruction due to tumour directly occluding the airway when a patient is sedated for percutaneous endoscopic gastrostomy.
  
  
  METHODS
  We report an audit of our experience of gastrostomy placement for patients under going treatment for head and neck cancer in our institution from September 2003 to October 2006.
  
  
  RESULTS
  Of 33 patients who had percutaneous endoscopic gastrostomy insertion under sedation in the first cycle of the audit, two (6%) experienced major airway complications resulting in one fatality. A tumour assessment protocol was introduced. In the second cycle, 96 patients had percutaneous endoscopic gastrostomies, of whom 16 (13%) underwent gastrostomy insertion under general anaesthetic and five (4.5%) under radiological guidance. No patients had airway complications or abdominal wall metastases.
  
  
  CONCLUSIONS
  A formal tumour assessment protocol eliminated airway obstruction as a complication of percutaneous endoscopic gastrostomy insertion and may reduce the potential for abdominal wall metastases at the gastrostomy site when using the pull technique.
authors.affiliation: Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK. richoakley@dr.com
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Oakley
authors.forename: Rachael
authors.initials: R
authors.lastname: Donnelly
authors.forename: Lesley
authors.initials: L
authors.lastname: Freeman
authors.forename: Terry
authors.initials: T
authors.lastname: Wong
authors.forename: Michele
authors.initials: M
authors.lastname: McCarthy
authors.forename: Frances
authors.initials: F
authors.lastname: Calman
authors.forename: Mary
authors.initials: M
authors.lastname: O'Connell
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jeannon
authors.forename: Ricard
authors.initials: R
authors.lastname: Simo
mesh_terms: D000402:Airway Obstruction / Q000517:prevention & control*; D002985:Clinical Protocols; D005773:Gastroscopy / Q000379:methods*; D005774:Gastrostomy / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008485:Medical Audit