Brief Article
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World J Gastroenterol. Feb 28, 2011; 17(8): 1004-1008
Published online Feb 28, 2011. doi: 10.3748/wjg.v17.i8.1004
Prophylactic PEG placement in head and neck cancer: How many feeding tubes are unused (and unnecessary)?
Mohammad F Madhoun, Matt M Blankenship, Derek M Blankenship, Greg A Krempl, William M Tierney
Mohammad F Madhoun, Matt M Blankenship, William M Tierney, Section of Gastroenterology, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
Derek M Blankenship, Department of Biostatistics, Institute for Health Care Research and Improvement, Baylor Health care System, Dallas, TX 75206, United States
Greg A Krempl, Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States
Author contributions: Madhoun MF and Blankenship MM were involved in data acquisition, design, analysis and writing the manuscript; Tierney WM and Krempl GA were involved in design, analysis, revision and final approval of the manuscript; Blankenship DM was involved in statistical analysis, writing and final approval of the manuscript.
Correspondence to: Mohammad F Madhoun, MD, Section of Gastroenterology, Department of Internal Medicine, University of Oklahoma Health Sciences Center, 920 SL. Young Blvd; WP1360, Oklahoma City, OK 73104, United States. mohammad-madhoun@ouhsc.edu
Telephone: +1-405-2715428 Fax: +1-405-2717186
Received: February 15, 2010
Revised: April 15, 2010
Accepted: April 22, 2010
Published online: February 28, 2011
Abstract

AIM: 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.

CONCLUSION: There is a high rate of unnecessary PEG placement when done prophylactically in patients with head and neck cancer.

Keywords: Head and neck cancer; Percutaneous gastrostomy tube; Prophylactic