title: Safety of pull-type and introducer percutaneous endoscopic gastrostomy tubes in oncology patients: a retrospective analysis.
abstract: BACKGROUND
  Percutaneous endoscopic gastrostomy (PEG) allows long-term tube feeding. Safety of pull-type and introducer PEG placement in oncology patients with head/neck or oesophageal malignancies is unknown.
  
  
  METHODS
  Retrospective analysis of 299 patients undergoing PEG tube placement between January 2006 and December 2008 revealed 57 oncology patients. All patients with head/neck or oesophageal malignancy were treated with chemo- and radiotherapy. In case of high-grade stenosis introducer Freka® Pexact PEG tube was placed (n = 24) and in all other patients (n = 33) conventional pull-type PEG tube. Short-term complications and mortality rates were compared.
  
  
  RESULTS
  Patients' characteristics and clinical status were comparable in both groups. Short-term complications were encountered in 11/24 (48%) introducer PEG patients as compared to only 4/33 (12%) pull-type PEG patients (P < 0.05). Accidental removal of the introducer PEG tube occurred in 4/24 (17%) with need for surgical intervention in 1 vs. 0/33 (0%, P < 0.05). Wound infection occurred in 3/24 (12%) leading to septic shock and admission to intensive care unit (ICU) in 1 vs. 3/33 (9%, NS). Finally, 3/24 gastrointestinal perforations (12%) resulted from a difficult placement procedure vs. 1/33 (3%), leading to urgent surgical intervention and admission to ICU. Two introducer PEG patients died at ICU, resulting in an overall mortality rate of 8% vs. 0% (P = 0.091).
  
  
  CONCLUSIONS
  The introducer Freka® Pexact PEG procedure for long-term tube feeding may lead to significantly higher complication and mortality rates in patients with head/neck or oesophageal malignancies treated with chemo- and radiotherapy. It is suggested to use the conventional pull-type PEG tube placement in this group of patients, if possible.
authors.affiliation: Antwerp University Hospital, Wilrijkstraat 10, B-2650 Antwerp, Belgium.
authors.forename: Evi
authors.initials: E
authors.lastname: Van Dyck
authors.forename: Elisabeth J
authors.initials: EJ
authors.lastname: Macken
authors.forename: Bernard
authors.initials: B
authors.lastname: Roth
authors.forename: Paul A
authors.initials: PA
authors.lastname: Pelckmans
authors.forename: Tom G
authors.initials: TG
authors.lastname: Moreels
mesh_terms: D000368:Aged; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate