Reference Citation Analysis: Find an Article, Find a Category, Find a Journal, Find a Scholar

For: Retes FA, Kawaguti FS, de Lima MS, da Costa Martins B, Uemura RS, de Paulo GA, Pennacchi CM, Gusmon C, Ribeiro AV, Baba ER, Geiger SN, Sorbello MP, Kulcsar MA, Ribeiro U, Maluf-Filho F. Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer. United European Gastroenterol J 2016;5:365-373. [PMID: 28507748 DOI: 10.1177/2050640616662160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/04/2016] [Indexed: 12/23/2022] Open

For:	Retes FA, Kawaguti FS, de Lima MS, da Costa Martins B, Uemura RS, de Paulo GA, Pennacchi CM, Gusmon C, Ribeiro AV, Baba ER, Geiger SN, Sorbello MP, Kulcsar MA, Ribeiro U, Maluf-Filho F. Comparison of the pull and introducer percutaneous endoscopic gastrostomy techniques in patients with head and neck cancer. United European Gastroenterol J 2016;5:365-373. [PMID: 28507748 DOI: 10.1177/2050640616662160] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/04/2016] [Indexed: 12/23/2022] Open

Number

Cited by Other Article(s)

Kohli DR, Cosgrove N, Abidi WM, Machicado JD, Desai M, Forbes N, Marya NB, Thiruvengadam NR, Thosani NC, Alipour O, Ngamruengphong S, Elhanafi SE, Sheth SG, Ruan W, Fang JC, McClave SA, Zvavanjanja RC, Radadiya DK, Kamel AY, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: methodology and review of evidence. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2025;10:1-23. [PMID: 39925405 PMCID: PMC11806427 DOI: 10.1016/j.vgie.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]

Affiliation(s)

Divyanshoo Rai Kohli Pancreas and Liver Clinic, Providence Sacred Medical Center, Elson Floyd School of Medicine, Washington State University, Spokane, Washington, USA
Natalie Cosgrove Center for Interventional Endoscopy AdventHealth, Orlando, Florida, USA
Wasif M Abidi Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
Jorge D Machicado Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
Madhav Desai Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
Nauzer Forbes Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Neil B Marya Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA
Nikhil R Thiruvengadam Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
Nirav C Thosani Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
Omeed Alipour Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
Saowanee Ngamruengphong Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
Sherif E Elhanafi Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Sunil G Sheth Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Wenly Ruan Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
John C Fang Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA
Stephen A McClave Department of Medicine, University of Louisville, Louisville, Kentucky, USA
Rodrick C Zvavanjanja Department of Diagnostic and Interventional Radiology at UTHealth, McGovern Medical School, Houston, Texas, USA
Dhruvil K Radadiya Department of Gastroenterology, Hepatology and Motility, University of Kansas, Kansas City, Kansas USA
Amir Y Kamel Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
Bashar J Qumseya Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA

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Kohli DR, Abidi WM, Cosgrove N, Machicado JD, Desai M, Forbes N, Marya NB, Thiruvengadam NR, Thosani NC, Alipour O, Ngamruengphong S, Elhanafi SE, Sheth SG, Ruan W, Fang JC, McClave SA, Zvavanjanja RC, Kamel AY, Qumseya BJ. American Society for Gastrointestinal Endoscopy guideline on gastrostomy feeding tubes: summary and recommendations. Gastrointest Endosc 2025;101:25-35. [PMID: 39520459 DOI: 10.1016/j.gie.2024.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 11/16/2024]

Affiliation(s)

Divyanshoo Rai Kohli Pancreas and Liver Clinic, Providence Sacred Medical Center, Elson Floyd School of Medicine, Washington State University, Spokane, Washington, USA
Wasif M Abidi Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas, USA
Natalie Cosgrove Center for Interventional Endoscopy AdventHealth, Orlando, Florida, USA
Jorge D Machicado Division of Gastroenterology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
Madhav Desai Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
Nauzer Forbes Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Neil B Marya Division of Gastroenterology, UMass Chan Medical School, Worcester, Massachusetts, USA
Nikhil R Thiruvengadam Division of Gastroenterology and Hepatology, Loma Linda University, Loma Linda, California, USA
Nirav C Thosani Center for Interventional Gastroenterology at UTHealth, McGovern Medical School, Houston, Texas, USA
Omeed Alipour Division of Gastroenterology, University of Washington Medical Center, Seattle, Washington, USA
Saowanee Ngamruengphong Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, Maryland, USA
Sherif E Elhanafi Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
Sunil G Sheth Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
Wenly Ruan Division of Pediatric Gastroenterology, Hepatology and Nutrition, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
John C Fang Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, Utah, USA
Stephen A McClave Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA
Rodrick C Zvavanjanja Department of Diagnostic and Interventional Radiology at UTHealth, McGovern Medical School, Houston, Texas, USA
Amir Y Kamel Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA; Department of Pharmacy, UF Health Shands Hospital, University of Florida College of Pharmacy, Gainesville, Florida, USA
Bashar J Qumseya Department of Gastroenterology, Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA

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Piñar-Gutiérrez A, González-Gracia L, Vázquez Gutiérrez R, García-Rey S, Jiménez-Sánchez A, González-Navarro I, Tatay-Domínguez D, Garrancho-Domínguez P, Remón-Ruiz PJ, Martínez-Ortega AJ, Serrano-Aguayo P, Giménez-Andreu MD, García-Fernández FJ, Bozada-García JM, Nacarino-Mejías V, López-Iglesias Á, Pereira-Cunill JL, García-Luna PP. Percutaneous Gastrostomies: Associated Complications in PUSH vs. PULL Techniques over 12 Years in a Referral Centre. J Clin Med 2024;13:1836. [PMID: 38610601 PMCID: PMC11012573 DOI: 10.3390/jcm13071836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/14/2024] Open

Affiliation(s)

Ana Piñar-Gutiérrez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Lucía González-Gracia UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Rocío Vázquez Gutiérrez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Silvia García-Rey UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Andrés Jiménez-Sánchez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Irene González-Navarro UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Dolores Tatay-Domínguez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Pilar Garrancho-Domínguez UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Pablo J. Remón-Ruiz UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Antonio J. Martínez-Ortega UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Pilar Serrano-Aguayo UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
María Dolores Giménez-Andreu UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Francisco José García-Fernández Unidad de Aparato Digestivo, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
Juan Manuel Bozada-García Unidad de Aparato Digestivo, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
Verónica Nacarino-Mejías Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
Álvaro López-Iglesias Unidad de Radiodiagnóstico, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain
José Luis Pereira-Cunill UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)
Pedro Pablo García-Luna UGC Endocrinología y Nutrición, Hospital Universitario Virgen del Rocio, 41013 Sevilla, Spain (L.G.-G.); (R.V.G.); (S.G.-R.); (I.G.-N.); (D.T.-D.); (P.G.-D.); (P.J.R.-R.); (A.J.M.-O.); (P.S.-A.); (M.D.G.-A.); (P.P.G.-L.)

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Tae CH, Lee JY, Joo MK, Park CH, Gong EJ, Shin CM, Lim H, Choi HS, Choi M, Kim SH, Lim CH, Byeon JS, Shim KN, Song GA, Lee MS, Park JJ, Lee OY. Clinical Practice Guideline for Percutaneous Endoscopic Gastrostomy. Gut Liver 2024;18:10-26. [PMID: 37850251 PMCID: PMC10791499 DOI: 10.5009/gnl230146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 10/19/2023] Open

Affiliation(s)

Chung Hyun Tae Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Ju Yup Lee Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
Moon Kyung Joo Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
Chan Hyuk Park Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
Eun Jeong Gong Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
Cheol Min Shin Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
Hyun Lim Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
Hyuk Soon Choi Division of Gastroenterology and Hepatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
Miyoung Choi National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
Sang Hoon Kim Department of Gastroenterology, Dongguk University Ilsan Hospital, Goyang, Korea Korean College of Helicobacter and Upper Gastrointestinal Research–Metabolism, Obesity & Nutrition Research Group, Seoul, Korea
Chul-Hyun Lim Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea Korean Society of Gastrointestinal Endoscopy–The Research Group for Endoscopes and Devices, Seoul, Korea
Jeong-Sik Byeon Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Ki-Nam Shim Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
Geun Am Song Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
Moon Sung Lee Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
Jong-Jae Park Division of Gastroenterology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
Oh Young Lee Department of Internal Medicine, Hanyang University School of Medicine, Seoul, Korea
The Korean Society of Gastrointestinal Endoscopy Task Force on Clinical Practice Guidelines

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Kucha P, Zorniak M, Szmit M, Lipczynski R, Wieszczy-Szczepanik P, Kapala A, Wojciechowska U, Didkowska J, Rupinski M, Olesinski T, Maj T, Regula J, Kaminski MF, Januszewicz W. To push or to pull? A clinical audit on the efficacy and safety of the pull and push percutaneous endoscopic gastrostomy techniques in oncological patients. United European Gastroenterol J 2023;11:951-959. [PMID: 37948117 PMCID: PMC10720683 DOI: 10.1002/ueg2.12467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/21/2023] [Indexed: 11/12/2023] Open

Abstract

BACKGROUND

The peroral "pull" technique and the direct "push" procedure are the two main methods for percutaneous endoscopic gastrostomy (PEG) placement. Although pull-PEG is generally recommended as the first-line modality, many oncological patients require a push-PEG approach to prevent tumor seeding or overcome tumor-related obstruction.

OBJECTIVE

We aimed to compare the efficacy and safety of both PEG procedures in cancer patients.

METHODS

We retrospectively analyzed all consecutive PEG procedures within a tertiary oncological center. Patients were followed up with the hospital databases and National Cancer Registry to assess the technical success rate for PEG placement, the rate of minor and major adverse events (AEs), and 30-day mortality rates. We compared those outcomes between the two PEG techniques. Finally, risk factors for PEG-related adverse events were analyzed using a multivariable Cox proportional-hazard regression model adjusted for patients' sex, age, performance status (ECOG), Body Mass Index (BMI), diabetes, chemoradiotherapy (CRT) status (pre-/current-/post-treatment), and type of PEG.

RESULTS

We included 1055 PEG procedures (58.7% push-PEG/41.4% pull-PEG) performed in 994 patients between 2014 and 2021 (mean age 62.0 [±10.7] yrs.; 70.2% males; indication: head-and-neck cancer 75.9%/other cancer 24.1%). The overall technical success for PEG placement was 96.5%. Although the "push" technique had a higher rate of all AEs (21.4% vs. 7.1%, Hazard Ratio [HR] = 2.9; 95% CI = 1.9-4.3, p < 0.001), most of these constituted minor AEs (71.9%), such as tube dislodgement. The methods had no significant difference regarding major AEs and 30-day mortality rates. Previous CRT was associated with an increased risk of major AEs (hazard ratio = 2.7, 95% CI = 1.0-7.2, p = 0.042).

CONCLUSION

The risk of major AEs was comparable between the push- and pull-PEG techniques in cancer patients. Due to frequent tube dislodgement in push-PEG, the pull technique may be more suitable for long-term feeding. Previous CRT increases the risk of major AEs, favoring early ("prophylactic") PEG placement when such treatment is expected.

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Affiliation(s)

Piotr Kucha Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
Michal Zorniak Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
Mateusz Szmit Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
Rafal Lipczynski Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
Paulina Wieszczy-Szczepanik Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland
Aleksandra Kapala Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Urszula Wojciechowska Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Joanna Didkowska Polish National Cancer Registry, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Maciej Rupinski Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Tomasz Olesinski Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Tomasz Maj Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Jaroslaw Regula Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Michal F Kaminski Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
Wladyslaw Januszewicz Department of Gastroenterology, Hepatology, and Clinical Oncology, Center of Postgraduate Medical Education, Warsaw, Poland Department of Oncological Gastroenterology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland

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Garcia JL, Rodrigues RV, Mão-de-Ferro S, Ferreira S, Serrano M, Castela J, Sacarrão R, Francisco F, Sousa L, Dias Pereira A. Impact of Percutaneous Endoscopic Gastrostomy Tube Feeding on Nutritional Status in Patients Undergoing Chemoradiotherapy for Oesophageal Cancer. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2023;30:350-358. [PMID: 37868632 PMCID: PMC10586218 DOI: 10.1159/000525853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/22/2022] [Indexed: 10/24/2023]

Abstract

Introduction

Oesophageal cancer causes dysphagia and weight loss. Malnutrition further worsens with multimodal treatment.

Aim

The aim of the study was to evaluate the impact of percutaneous endoscopic gastrostomy (PEG) placement in the nutritional status of patients with oesophageal cancer requiring chemoradiotherapy (CRT).

Methods

A comparative study with a prospective arm and a historical cohort was conducted. Oesophageal cancer patients undergoing CRT with dysphagia grade >2 and/or weight loss >10% were submitted to PEG-tube placement (pull method) before CRT. Stoma seeding was evaluated through a swab obtained after placement and, in surgical patients, the resected stoma. A matched historical cohort without PEG placement was used as control (trial ACTRN12616000697482).

Results

Twenty-nine patients (intervention group, IG) were compared to 30 patients (control group, CG). Main outcomes did not differ in the IG and CG: weight loss during CRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg (p = 0.503); 6-month mortality after CRT or surgery 17.2% versus 26.7% (p = 0.383); perioperative complication rate 54.5% versus 55.6% (p = 1.000); unplanned hospital admissions 34.5% versus 40.0% (p = 0.661). In the CG, during CRT, 14 (46.7%) patients presented with dysphagia grade 3-4, of whom 12 required nasogastric tube feeding (n = 10), surgical gastrostomy (n = 1), and oesophageal dilation (n = 1). In the IG, 89.7% used the PEG tube during CRT, sometimes exclusively in 51.7%. Adverse events were mainly minor (n = 12, 41.4%), mostly late peristomal infections, 1 major complication (exploratory laparotomy due to suspected colonic interposition, not confirmed). There was no cytological or histological evidence of stomal tumour seeding.

Conclusion

Weight loss, hospital admissions, surgical complications, and mortality were identical in oesophageal cancer patients referred for CRT, regardless of prophylactic PEG. However, half of the patients required exclusive enteral nutritional support, making PEG-tube placement an alternative to consider.

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Xu Y, Peng H, Guo Q, Guo L, Peng X, Lin S. Effect of Percutaneous Endoscopic Gastrostomy on Quality of Life after Chemoradiation for Locally Advanced Nasopharyngeal Carcinoma: A Cross-Sectional Study. Curr Oncol 2023;30:1000-1009. [PMID: 36661725 PMCID: PMC9857610 DOI: 10.3390/curroncol30010076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023] Open

Forner D, Mok F, Verma N, Karam I, Goldstein D, Higgins K, Enepekides D, Nadler A, Pugash R, Husain Z, Chan K, Smoragiewicz M, Cohen L, Hazey JW, Fung EC, Kang SY, Seim NB, Simpson C, Eskander A. Placement technique impacts gastrostomy tube-related complications amongst head and neck cancer patients. Oral Oncol 2022;130:105903. [DOI: 10.1016/j.oraloncology.2022.105903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/17/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]

Rajan A, Wangrattanapranee P, Kessler J, Kidambi TD, Tabibian JH. Gastrostomy tubes: Fundamentals, periprocedural considerations, and best practices. World J Gastrointest Surg 2022;14:286-303. [PMID: 35664365 PMCID: PMC9131834 DOI: 10.4240/wjgs.v14.i4.286] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open

Li X, Wang JX, Wang YP, Shen JX, Zheng YX, Zhang PH, Wei JJ, Zhuang ZH. Comparison of Pull and Introducer Techniques for Percutaneous Endoscopic Gastrostomy. J Multidiscip Healthc 2022;15:733-741. [PMID: 35411150 PMCID: PMC8994609 DOI: 10.2147/jmdh.s356865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open

Bouchiba H, Jacobs MAJM, Bouma G, Ramsoekh D. Outcomes of push and pull percutaneous endoscopic gastrostomy placements in 854 patients: A single‐center study. JGH Open 2021;6:57-62. [PMID: 35071789 PMCID: PMC8762618 DOI: 10.1002/jgh3.12694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/12/2023]

Querichelli AFA, Faria FL, Martinez LF, Campos Junior ED. Squamous cell carcinoma implantation in gastrostomy orifice. Case report. EINSTEIN-SAO PAULO 2020;18:eRC5409. [PMID: 33174970 PMCID: PMC7607919 DOI: 10.31744/einstein_journal/2020rc5409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/16/2020] [Indexed: 11/05/2022] Open

Chang A, Watcharamon C, Rattanasupa A, Thongsonkleeb K, Chowdok B, Khaimook A, Ovartlarnporn B, Prachayakul V. Comparison of Clinical Outcomes Between Surgical Gastrostomy and Percutaneous Endoscopic Gastrostomy with Introducer Technique in Patients with Upper Aerodigestive Malignancies: A Single-Center Analysis. World J Surg 2020;44:3070-3076. [PMID: 32358639 DOI: 10.1007/s00268-020-05532-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]

Abstract

BACKGROUND

Conventional percutaneous endoscopic gastrostomy (PEG) in patients with upper aerodigestive malignancies inevitably carries a risk of stomal metastasis that could be avoided by the direct insertion of the gastrostomy tube through the abdomen. This study compared the efficacy and safety between surgical gastrostomy (SG) and Introducer PEG in patients with upper aerodigestive malignancies.

METHODS

We retrospectively reviewed patients with upper aerodigestive malignancies undergoing SG or Introducer PEG. Procedure data, postprocedural clinical outcomes and 30-day mortality were assessed.

RESULTS

In total, 99 patients were feasible to analysis: 53 were in the SG group, and 46 were in the Introducer PEG group. The SG group had a higher incidence of (in-hospital) major complications [28.3% VS 4.3%, p = 0.002], a longer procedure duration [52.02 ± 21.30 VS 21.46 ± 8.22 min, p < 0.001], higher pain scores at 24 h [median (interquartile range, IQR); 5(3-8) VS 1(0-5), p < 0.001] and longer length of hospitalization (LOH) [median (IQR); 5(4-6) days VS 3(2-4) days, p < 0.001)]. In-hospital (3.8% VS 0%, p = 0.493) and 30-day mortality (17.0% VS 13.0%, p = 0.586) were not different between the two groups. In univariate analysis, high BMI, anemia (hemoglobin <11 g/dL), normal nutritional status (serum albumin >3 g/dL) and procedural type were found to be predicting factors for complications. Procedural type (Introducer PEG) was an independent factor for major complications in multivariate analysis [OR = 0.12, 95% CI 0.02-0.61, p= 0.011].

CONCLUSIONS

In patients with upper aerodigestive malignancies, Introducer PEG was associated with lower rate of (in-hospital) major complications, faster operative time, lower pain scores and shorter LOH.

CLINICAL TRIALS REGISTRY NUMBER

TCTR20181220004.

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Siu J, Fuller K, Nadler A, Pugash R, Cohen L, Deutsch K, Enepekides D, Karam I, Husain Z, Chan K, Singh S, Poon I, Higgins K, Xu B, Eskander A. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020;91:1005-1014.e17. [PMID: 31926149 DOI: 10.1016/j.gie.2019.12.045] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]

Abstract

BACKGROUND AND AIMS

Metastasis to the gastrostomy site in patients with upper aerodigestive tract (UADT) malignancies is a rare but devastating adverse event that has been poorly described. Our aim was to determine the overall incidence and clinicopathologic characteristics observed with development of gastrostomy site metastasis in patients with UADT cancers.

METHODS

This was a systematic review and meta-analysis of 6138 studies retrieved from Medline, EMBASE, CINAHL, and the Cochrane Register after being queried for studies including gastrostomy site metastasis in patients with UADT malignancies.

RESULTS

The final analysis included 121 studies. Pooled analysis showed an overall event rate gastrostomy site metastasis of .5% (95% confidence interval [CI], .4%-.7%). Subgroup analysis showed an event rate of .56% (95% CI, .40%-.79%) with the pull technique and .29% (95% CI, .15%-.55%) with the push technique. Clinicopathologic characteristics observed with gastrostomy site metastasis were late-stage disease (T3/T4) (57.8%), positive lymph node status (51.2%), and no evidence of systemic disease (M0) (62.8%) at initial presentation. The average time from gastrostomy placement to diagnosis of metastasis was 7.78 ± 4.9 months, average tumor size on detection was 4.65 cm (standard deviation, 2.02), and average length of survival was 7.26 months (standard deviation, 6.23).

CONCLUSIONS

Gastrostomy site metastasis is a rare but serious adverse event that occurs at an overall rate of .5%, particularly in patients with advanced-stage disease, and is observed with a very poor prognosis. These findings emphasize a need for clinical practice guidelines to include a regular assessment of the PEG site and highlight the importance of detection and management of gastrostomy site metastasis by the multidisciplinary care oncology team.

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Affiliation(s)

Jennifer Siu Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
Kaitlin Fuller Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada
Ashlie Nadler Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
Robyn Pugash Vascular/Interventional Radiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Lawrence Cohen Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Konrado Deutsch Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
Danny Enepekides Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Irene Karam Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Zain Husain Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Kelvin Chan Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
Simron Singh Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Ian Poon Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Kevin Higgins Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Bin Xu Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
Antoine Eskander Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, Michael Garron Hospital, Toronto, Ontario, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Science, Toronto, Ontario, Canada

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Nunes G, Fonseca J, Barata AT, Dinis-Ribeiro M, Pimentel-Nunes P. Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique? GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2020;27:172-184. [PMID: 32509923 PMCID: PMC7250336 DOI: 10.1159/000502981] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/27/2019] [Indexed: 12/18/2022]

Abstract

BACKGROUND

Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting.

SUMMARY

This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care.

CONCLUSIONS

Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

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