title: Prophylactic PEG placement in head and neck cancer: how many feeding tubes are unused (and unnecessary)?
abstract: OBJECTIVE
  To determine the rate of use and non-use of prophylactic percutaneous endoscopic gastrostomy (PEG) tubes among patients with head and neck cancer (HNC) patients.
  
  
  METHODS
  All patients with HNC undergoing PEG between January 1, 2004 and June 30, 2006 were identified. Patients (or their next-of-kin) were surveyed by phone and all available medical records and cancer registry data were reviewed. Prophylactic PEG was defined as placement in the absence of dysphagia and prior to radiation or chemoradiation. Each patient with a prophylactic PEG was assessed for cancer diagnosis, type of therapy, PEG use, and complications related to PEG.
  
  
  RESULTS
  One hundred and three patients had PEG tubes placed for HNC. Thirty four patients (33%) could not be contacted for follow-up. Of the 23 (22.3%) patients with prophylactic PEG tubes, 11/23 (47.8%) either never used the PEG or used it for less than 2 wk. No association with PEG use vs non-use was observed for cancer diagnosis, stage, or specific cancer treatment. Non-use or limited use was observed in 3/6 (50%) treated with radiation alone vs 8/17 (47.1%) treated with chemoradiation (P = 1.0), and 3 of 10 (30%) treated with surgery vs 8 of 13 (62%) not treated with surgery (P = 0.21). Minor complications were reported in 5/23 (21.7%). One (4.3%) major complication was reported.
  
  
  CONCLUSIONS
  There is a high rate of unnecessary PEG placement when done prophylactically in patients with head and neck cancer.
authors: Section of Gastroenterology, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, 73104, United States. mohammad-madhoun@ouhsc.edu
authors: Mohammad F
authors: MF
authors: Madhoun
authors: Matt M
authors: MM
authors: Blankenship
authors: Derek M
authors: DM
authors: Blankenship
authors: Greg A
authors: GA
authors: Krempl
authors: William M
authors: WM
authors: Tierney
mesh_terms: D000328:Adult; D000368:Aged; D002100:Cachexia / Q000517:prevention & control; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects / Q000706:statistics & numerical data*; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult