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Feasibility and Safety of Overtubes for PEG-Tube Placement in Patients with Head and Neck Cancer.

Musumba CO, Hsu J, Ahlenstiel G, Tutticci NJ, Nanda KS, van der Poorten D, Lee EY, Kwan V - Gastroenterol Res Pract (2015)

Bottom Line: Results.Conclusions.Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia.

ABSTRACT
Background. Percutaneous endoscopic gastrostomy (PEG) placement using the "pull" technique is commonly utilized for providing nutritional support in head and neck cancer (HNC) patients, but it may be complicated by peristomal metastasis in up to 3% of patients. Overtube-assisted PEG placement might reduce this risk. However, this technique has not been systemically studied for this purpose to date. Methods. Retrospective analysis of consecutive patients with HNC who underwent overtube-assisted PEG placement at Westmead Hospital, Australia, between June 2011 and December 2013. Data were extracted from patients' endoscopy reports and case notes. We present our technique for PEG insertion and discuss the feasibility and safety of this method. Results. In all 53 patients studied, the PEG tubes were successfully placed using 25 cm long flexible overtubes, in 89% prophylactically (before commencing curative chemoradiotherapy), and in 11% reactively (for treatment of tumor related dysphagia or weight loss). During a median follow-up period of 16 months, 3 (5.7%) patients developed peristomal infection and 3 others developed self-limiting peristomal pain. There were no cases of overtube-related adverse events or overt cutaneous metastases observed. Conclusions. Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.

No MeSH data available.


Related in: MedlinePlus

Step-by-step directions for positioning overtube. (a) Guardus overtube with correct snug fit of scope. (b) The inner and outer surfaces of both tubes are generously lubricated using a water-soluble lubricant (not water). (c) The fully lubricated inner tube is inserted into the fully lubricated outer tube and “backloaded” onto the scope, positioning the assembled Guardus overtube at the proximal end of the scope. (d) After performing baseline esophagoscopy, the overtube assembly is gently inserted into the esophagus through the bite block (use of a 60 F bite block is recommended). The inner tube and scope are then simultaneously removed, leaving the outer tube in place. (e) The insufflation cap is attached. This minimizes backflow of bodily fluids and maintains insufflation throughout the procedure. (f) The scope is reintroduced through the insufflation cap into the stomach (courtesy of US Endoscopy, Mentor, OH). PEG placement then proceeds using the standard Guederer-Ponsky “pull” technique, with the catheter pulled through the outer overtube still maintained in the esophagus.
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fig2: Step-by-step directions for positioning overtube. (a) Guardus overtube with correct snug fit of scope. (b) The inner and outer surfaces of both tubes are generously lubricated using a water-soluble lubricant (not water). (c) The fully lubricated inner tube is inserted into the fully lubricated outer tube and “backloaded” onto the scope, positioning the assembled Guardus overtube at the proximal end of the scope. (d) After performing baseline esophagoscopy, the overtube assembly is gently inserted into the esophagus through the bite block (use of a 60 F bite block is recommended). The inner tube and scope are then simultaneously removed, leaving the outer tube in place. (e) The insufflation cap is attached. This minimizes backflow of bodily fluids and maintains insufflation throughout the procedure. (f) The scope is reintroduced through the insufflation cap into the stomach (courtesy of US Endoscopy, Mentor, OH). PEG placement then proceeds using the standard Guederer-Ponsky “pull” technique, with the catheter pulled through the outer overtube still maintained in the esophagus.

Mentions: All procedures were undertaken under doctor/nurse-administered conscious sedation using a combination of fentanyl, midazolam, and propofol. When necessary, anesthetic support was utilized in patients deemed to be at high risk of sedation-related complications. Patients were placed in a supine position with the head in a neutral position. All patients received prophylactic antibiotics intravenously using a 3rd generation cephalosporin prior to the procedure. A 25 cm long, single-use, flexible overtube (Guardus; US Endoscopy, Mentor, OH) was used. This overtube system comprises a tapered inner tube that snugly fits around a standard endoscope (8.6–10.8 mm diameter) and an outer slightly shorter and wider coil-spring reinforced tube, both incorporating an air seal at their proximal ends (Figure 1). Figure 2 demonstrates the step-by-step technique of inserting the Guardus overtube. A standard gastroscope was then introduced with the overtube in place. Subsequent placement of an endoscopically removable 20 F Bard gastrostomy tube (Bard Access Systems, Salt Lake City, UT) was performed using the standard “pull” technique, as previously described by Gauderer and Ponsky [25, 26], with the tube pulled through the overtube [25, 26]. Final position of the PEG tube was confirmed by relook endoscopy, after which the gastroscope and overtube assembly were removed.


Feasibility and Safety of Overtubes for PEG-Tube Placement in Patients with Head and Neck Cancer.

Musumba CO, Hsu J, Ahlenstiel G, Tutticci NJ, Nanda KS, van der Poorten D, Lee EY, Kwan V - Gastroenterol Res Pract (2015)

Step-by-step directions for positioning overtube. (a) Guardus overtube with correct snug fit of scope. (b) The inner and outer surfaces of both tubes are generously lubricated using a water-soluble lubricant (not water). (c) The fully lubricated inner tube is inserted into the fully lubricated outer tube and “backloaded” onto the scope, positioning the assembled Guardus overtube at the proximal end of the scope. (d) After performing baseline esophagoscopy, the overtube assembly is gently inserted into the esophagus through the bite block (use of a 60 F bite block is recommended). The inner tube and scope are then simultaneously removed, leaving the outer tube in place. (e) The insufflation cap is attached. This minimizes backflow of bodily fluids and maintains insufflation throughout the procedure. (f) The scope is reintroduced through the insufflation cap into the stomach (courtesy of US Endoscopy, Mentor, OH). PEG placement then proceeds using the standard Guederer-Ponsky “pull” technique, with the catheter pulled through the outer overtube still maintained in the esophagus.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4419231&req=5

fig2: Step-by-step directions for positioning overtube. (a) Guardus overtube with correct snug fit of scope. (b) The inner and outer surfaces of both tubes are generously lubricated using a water-soluble lubricant (not water). (c) The fully lubricated inner tube is inserted into the fully lubricated outer tube and “backloaded” onto the scope, positioning the assembled Guardus overtube at the proximal end of the scope. (d) After performing baseline esophagoscopy, the overtube assembly is gently inserted into the esophagus through the bite block (use of a 60 F bite block is recommended). The inner tube and scope are then simultaneously removed, leaving the outer tube in place. (e) The insufflation cap is attached. This minimizes backflow of bodily fluids and maintains insufflation throughout the procedure. (f) The scope is reintroduced through the insufflation cap into the stomach (courtesy of US Endoscopy, Mentor, OH). PEG placement then proceeds using the standard Guederer-Ponsky “pull” technique, with the catheter pulled through the outer overtube still maintained in the esophagus.
Mentions: All procedures were undertaken under doctor/nurse-administered conscious sedation using a combination of fentanyl, midazolam, and propofol. When necessary, anesthetic support was utilized in patients deemed to be at high risk of sedation-related complications. Patients were placed in a supine position with the head in a neutral position. All patients received prophylactic antibiotics intravenously using a 3rd generation cephalosporin prior to the procedure. A 25 cm long, single-use, flexible overtube (Guardus; US Endoscopy, Mentor, OH) was used. This overtube system comprises a tapered inner tube that snugly fits around a standard endoscope (8.6–10.8 mm diameter) and an outer slightly shorter and wider coil-spring reinforced tube, both incorporating an air seal at their proximal ends (Figure 1). Figure 2 demonstrates the step-by-step technique of inserting the Guardus overtube. A standard gastroscope was then introduced with the overtube in place. Subsequent placement of an endoscopically removable 20 F Bard gastrostomy tube (Bard Access Systems, Salt Lake City, UT) was performed using the standard “pull” technique, as previously described by Gauderer and Ponsky [25, 26], with the tube pulled through the overtube [25, 26]. Final position of the PEG tube was confirmed by relook endoscopy, after which the gastroscope and overtube assembly were removed.

Bottom Line: Results.Conclusions.Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Westmead Hospital, Westmead, Sydney, NSW 2145, Australia.

ABSTRACT
Background. Percutaneous endoscopic gastrostomy (PEG) placement using the "pull" technique is commonly utilized for providing nutritional support in head and neck cancer (HNC) patients, but it may be complicated by peristomal metastasis in up to 3% of patients. Overtube-assisted PEG placement might reduce this risk. However, this technique has not been systemically studied for this purpose to date. Methods. Retrospective analysis of consecutive patients with HNC who underwent overtube-assisted PEG placement at Westmead Hospital, Australia, between June 2011 and December 2013. Data were extracted from patients' endoscopy reports and case notes. We present our technique for PEG insertion and discuss the feasibility and safety of this method. Results. In all 53 patients studied, the PEG tubes were successfully placed using 25 cm long flexible overtubes, in 89% prophylactically (before commencing curative chemoradiotherapy), and in 11% reactively (for treatment of tumor related dysphagia or weight loss). During a median follow-up period of 16 months, 3 (5.7%) patients developed peristomal infection and 3 others developed self-limiting peristomal pain. There were no cases of overtube-related adverse events or overt cutaneous metastases observed. Conclusions. Overtube-assisted PEG placement in patients with HNC is a feasible, simple, and safe technique and might be effective for preventing cutaneous metastasis.

No MeSH data available.


Related in: MedlinePlus