title: Does prior percutaneous endoscopic gastrostomy alter post-operative outcome after esophagectomy.
abstract: BACKGROUND
  With the introduction of neoadjuvant chemoradiotherapy in patients with esophageal carcinoma, nutritional access has become essential to counter deleterious effects of dysphagia. Current NCCN guidelines do not recommend PEG prior to esophagectomy in these patients, but there is little evidence for this recommendation. The objective of this study was to compare outcomes in patients who underwent esophagectomy with or without prior PEG placement.
  
  
  METHODS
  We retrospectively reviewed 96 patients who underwent esophagectomy between 2005 and 2012 for esophageal carcinoma. Patients were divided into two groups; Group I (PEG +ve) and Group II (PEG -ve). Patient characteristics, operative variables, and post-operative complications were compared. χ (2) and Fisher's test were used for categorical, while t test was used for interval variables.
  
  
  RESULTS
  Median age was 51(18-70) years. Lower thoracic tumors were more common in Group I (69 vs. 63 %) (P = 0.04) and more patients underwent minimally invasive surgery in this group (50 vs. 2.6 %) (P < 0.0001). Mean blood loss (326 vs. 465 ml) (P = 0.02) and ICU stay (1.6 vs. 4.3 days) (P = 0.01) were significantly lower in Group I. There was no 30-day mortality in Group I versus 10.5 % in Group II (P = 0.01). No significant difference in anastomotic leak and stricture rate was observed. Gastric conduit was used in all patients for reconstruction. One patient had malignancy in PEG site biopsy.
  
  
  CONCLUSIONS
  Percutaneous endoscopic gastrostomy before esophagectomy is safe and does not adversely impact post-operative outcomes.
authors.affiliation: Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, abubakar.hafeez@yahoo.com.
authors.forename: Abu Bakar Hafeez
authors.initials: AB
authors.lastname: Bhatti
authors.forename: Farrukh Hassan
authors.initials: FH
authors.lastname: Rizvi
authors.forename: Anum
authors.initials: A
authors.lastname: Waheed
authors.forename: Syed Hassan
authors.initials: SH
authors.lastname: Raza
authors.forename: Aamir Ali
authors.initials: AA
authors.lastname: Syed
authors.forename: Shahid
authors.initials: S
authors.lastname: Khattak
authors.forename: M
authors.initials: M
authors.lastname: Aasim Yusuf
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000209:etiology; D016063:Blood Loss, Surgical; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000601:surgery*; D003251:Constriction, Pathologic / Q000209:etiology; D003422:Critical Care; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D004944:Esophagoplasty; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011184:Postoperative Period; D011300:Preoperative Care; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult