Adaptation of a bronchofiberscope for percutaneous endoscopic gastrostomy

Flexible Bronchoscope Use by Pulmonologists in Collaboration With Gastroenterologists for Placement of Percutaneous Endoscopic Gastrostomy Via Transnasal Route in Patients With Head and Neck Cancer: A 10-Year Experience in a Single Cancer Institution

This study was conducted with the aim of evaluating a 10-year experience in the Pulmonology Department of a cancer center for percutaneous endoscopic gastrostomy through transnasal route (TN-PEG) in patients with head and neck cancer whose oral access is precluded. This study was a retrospective analysis of 40 consecutive head and neck cancer patients referred for PEG placement, between 2005 and 2014, using a transnasal route because of the impossibility of intubation through the oral cavity. Demographics, outcome of TN-PEG procedure, indications for bronchoscopic approach (prophylactic/palliative), clinical need for bronchoscopy (trismus, oropharyngeal obstruction), location of cancer, complications, and overall survival were reviewed. In 40 TN-PEG procedures, executed by 1 of 3 pulmonologists, 39 were successfully placed and there were no immediate complications. All except 1 complication were minor, but no surgery or PEG removal was required. There was a rapid learning curve among all operators. A combined TN-PEG placement by a gastroenterologist and a pulmonologist is a safe and useful option for these patients; the learning curve for successfully performing the procedure was short.

Endoscopic intervention for enteral access

Contrary to total parenteral nutrition with its relatively recent introduction into modern clinical medicine, enteral nutrition has a long and colorful history. Prior to development of fiberoptic endoscopy, physicians attempting to feed patients who could not or would not eat were limited to the blind placement of intestinal tubes or radiologically assisted placement of these devices. Previous to these modern attempts, the use of nutrient enemas was attempted for which there was evidence of occasional success. With the introduction of fiberoptic flexible endoscopy, guidance of tubes into the upper intestinal tract under direct vision became feasible. The manner in which tubes were positioned, advanced, or manipulated are myriad and attest to the ingenuity of clinicians. A revolution in endoscopic intervention occurred with the introduction of the percutaneous endoscopic gastrostomy in 1980. This provided secure access to the stomach without a laparotomy. This technique was also modified to allow decompression of the stomach with feeding distally into the small intestine and also direct puncture and placement of tubes into the small intestine. The most recent advance in enteral nutrition is taking place at the present time with the introduction of laparoscopic techniques in the creation of gastrostomies and jejunostomies.