title: Percutaneous endoscopic gastrostomy using the direct method for aerodigestive cancer patients.
abstract: BACKGROUND
  In esophageal or head and neck cancer patients, percutaneous endoscopic gastrostomy (PEG) by the pull method has higher complication rates than in noncancer patients. An introducer method is considered suitable for these patients, however, complications associated with deflation or rupture of the balloon-anchoring system are reported.
  
  
  OBJECTIVE
  To investigate the efficacy of a modified introducer method, called direct method, for aerodigestive cancer patients.
  
  
  METHODS
  Between October 2007 and December 2010, direct-method PEG was performed in 160 patients with advanced-stage esophageal (59 patients) or head and neck (101 patients) cancer. Complications and postoperative course were retrospectively retrieved from charts.
  
  
  RESULTS
  An ultrathin endoscopy was used in 109 patients (72.7%), and 23 patients received previous endoscopic dilatation (14%) due to the stricture caused by the tumor. The success rate of tube placement was 98.8% (158/160). Major complications related to tube insertion, such as panperitonitis, gastrointestinal hemorrhage, and postoperative pneumonia occurred in five patients (3.2%). One patient died for panperitonitis due to late-onset tube dislodgement. There were no cases of tube blockade and no metastases in the PEG site during the median follow-up period of 153 days.
  
  
  CONCLUSIONS
  This was the first report of direct-method PEG in a number of esophageal or head and neck cancer patients. This method is optimal for its high success rate, acceptable safety profile, and little risk of stomal metastasis.
authors.affiliation: Division of Endoscopy, Shizuoka Cancer Center, Shimonagakubo, Nagaizumi, Suntogun, Shizuoka, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yagishita
authors.forename: Naomi
authors.initials: N
authors.lastname: Kakushima
authors.forename: Masaki
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kohei
authors.initials: K
authors.lastname: Takizawa
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Yamaguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Matsubayashi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005773:Gastroscopy / Q000009:adverse effects / Q000379:methods; D005774:Gastrostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016896:Treatment Outcome