title: A new large-caliber trocar for percutaneous endoscopic gastrostomy by the introducer technique in head and neck cancer patients.
abstract: OBJECTIVE
  In many patients, percutaneous endoscopic gastrostomy (PEG) can be limited by digestive tract stenosis. PEG placement using an introducer is the safest alternative for this group of patients, but the available devices are difficult to implement and require smaller-caliber tubes. The aim of this study was to evaluate the modification of an introducer technique device for PEG placement with regard to the following: procedure feasibility, possibility of using a 20-Fr balloon gastrostomy tube, tube-related function and problems, complications, procedure safety, and mortality.
  
  
  METHODS
  Between March 2007 and February 2008, 30 consecutive patients with head and neck malignancies underwent introducer PEG placement with the modified device and gastropexy. Each patient was evaluated for 60 days after the procedure for the success of the procedure, infection, pain, complications, mortality, and problems with the procedure.
  
  
  RESULTS
  The procedure was successful in all cases with no perioperative complications. No signs of stomal infection were observed using the combined infection score. The majority of patients experienced mild-to-moderate pain both in the immediate postoperative period and at 72 hours. One major early complication (3.3%) and two minor complications (6.7%) were observed. No procedure-related deaths occurred during the first 60 days after the procedure.
  
  
  CONCLUSIONS
  The device modification for PEG using the introducer technique is feasible, safe, and efficient in outpatients with obstructive head and neck cancer. In this series, it allowed the use of a larger-caliber tube with low complication rates and no procedure-related mortality.
authors.affiliation: Department of Gastroenterology, Hospital das Clínicas, Medical School of São Paulo University, São Paulo, Brazil. drgiordano@hotmail.com
authors.forename: J H
authors.initials: JH
authors.lastname: Giordano-Nappi
authors.forename: F
authors.initials: F
authors.lastname: Maluf-Filho
authors.forename: S
authors.initials: S
authors.lastname: Ishioka
authors.forename: F Y
authors.initials: FY
authors.lastname: Hondo
authors.forename: S E
authors.initials: SE
authors.lastname: Matuguma
authors.forename: M
authors.initials: M
authors.lastname: Simas de Lima
authors.forename: M
authors.initials: M
authors.lastname: Lera dos Santos
authors.forename: F A
authors.initials: FA
authors.lastname: Retes
authors.forename: P
authors.initials: P
authors.lastname: Sakai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications*; D003251:Constriction, Pathologic / Q000209:etiology; D004750:Enteral Nutrition; D004940:Esophageal Stenosis / Q000209:etiology; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D010614:Pharynx / Q000473:pathology; D013997:Time Factors; D014313:Trismus / Q000209:etiology