Comparison between nasogastric tube feeding and percutaneous fluoroscopic gastrostomy in advanced had and neck cancer
Wasting is a major complication of advanced head and neck cancer and the aim of this study was to compare nasogastric tube feeding (NG) and percutaneous fluoroscopic gastrostomy (PFG) in these patients. The goal of these two methods of nutritional support was to improve or maintain the initial nutritional status during treatment. A total of 90 patients, all stage IV oropharynx or hypopharynx tumor, were reviewed from a prospective databank. All these patients were treated by concomitant chemotherapy and twice-daily continuous radiotherapy with no acceleration. Fifty patients were managed by PFG, and the rest by NG. Mechanical failure, duration of feeding, complications, nutritional evaluation and quality of life were analysed. Mechanical failure occurred in 32 of the 40 NG patients and in seven of the gastrostomy group. In the PFG group, 80% of patients conserved their nutritional support after the end of the radiotherapy, none patient in the NG group. In the PFG group, two presented a wound infection and six had aspiration pneumonia while in the NG group, 21 had aspiration pneumonia probably due to the NG tube (gastroesophageal reflux). The feeding methods were found to be equally effective at maintaining body weight and body mass index at time 1 (3 weeks) and at time 2 (6 weeks). Advantages were associated with PFG cosmesis, mobility and quality of life. PFG is a safe and effective method of providing enteral nutrition during treatment to patients with advanced head and neck cancer and offers important advantages over NG.
Available from: PubMed Central
- "The survival outcome was reported in three articles for 30 d after catheterization , 6 months after completion of the study , and 3 years after the start of radiotherapy , respectively. The data in these articles indicated that 12%  and 22%  of the gastrostomy group and 10%  and 34%  of the NG group at 30 days after catheterization, and 6 months after completion of the study. In one study , the authors determined the survival outcome for the three choices of feeding routes for oropharyngeal carcinomas: 70% in the prophylactic gastrostomy group, 41.7% in the therapeutic gastrostomy group, and 85.7% in the NGT group 3 years after the commencement of radiotherapy. "
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ABSTRACT: There are two main enteral feeding strategies—namely nasogastric (NG) tube feeding and percutaneous gastrostomy—used to improve
the nutritional status of patients with head and neck cancer (HNC). But up till now there has been no consistent evidence
about which method of enteral feeding is the optimal method for this patient group. To compare the effectiveness of percutaneous
gastrostomy and NGT feeding in patients with HNC, relevant literature was identified through Medline, Embase, Pubmed, Cochrane,
Wiley and manual searches. We included randomized controlled trials (RCTs) and non-experimental studies comparing percutaneous
gastrostomy—including percutaneous endoscopic gastrostomy (PEG) and percutaneous fluoroscopic gastrostomy (PFG) —with NG for
HNC patients. Data extraction recorded characteristics of intervention, type of study and factors that contributed to the
methodological quality of the individual studies. Data were then compared with respect to nutritional status, duration of
feeding, complications, radiotherapy delays, disease-free survival and overall survival. Methodological quality of RCTs and
non-experimental studies were assessed with separate standard grading scales. It became apparent from our studies that both
feeding strategies have advantages and disadvantages.
- "In general, it can be stated that a 10% loss of body weight is not uncommon following head and neck radiotherapy (Lees, 1999). In severe cases of weight loss, enteral nutrition either by, e.g., a nasogastric tube or a percutaneous endoscopic gastrostomy (PEG) may become necessary (Magne et al., 2001; Mekhail et al., 2001). Patients often prefer a PEG rather than a nasogastric tube, but it has been reported that a PEG is often required for longer periods of time and is associated with more persistent dysphagia and an increased need for pharyngo-esophageal dilatation (Mekhail et al., 2001). "
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ABSTRACT: In addition to anti-tumor effects, ionizing radiation causes damage in normal tissues located in the radiation portals. Oral complications of radiotherapy in the head and neck region are the result of the deleterious effects of radiation on, e.g., salivary glands, oral mucosa, bone, dentition, masticatory musculature, and temporomandibular joints. The clinical consequences of radiotherapy include mucositis, hyposalivation, taste loss, osteoradionecrosis, radiation caries, and trismus. Mucositis and taste loss are reversible consequences that usually subside early post-irradiation, while hyposalivation is normally irreversible. Furthermore, the risk of developing radiation caries and osteoradionecrosis is a life-long threat. All these consequences form a heavy burden for the patients and have a tremendous impact on their quality of life during and after radiotherapy. In this review, the radiation-induced changes in healthy oral tissues and the resulting clinical consequences are discussed.
Available from: Okan Akhan
- "Patients such as scleroderma, short gut syndrome , radiation enteritis or Crohn disease could tolerate and absorb elemental diet infused slowly to small bowel through percutaneous gastrojejunostomy or jejunostomy . PRG have also been performed in anorexia nervosa, cachexia, severe depression, cystic fibrosis, multiorgan failure, massive burn or advanced malignancy cases requiring nutritional support     "
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ABSTRACT: Gastrostomy is a preferred method of nutrition in patients with impaired ability to eat. Although surgical gastrostomy is a well-established method and has been widely performed in the last century, beginning with early 1980s, percutaneous gastrostomy techniques, either endoscopic or radiologic, has widely gained acceptance. As percutaneous methods have been shown to be an effective, safe, easy to perform and low-cost techniques with low morbidity and mortality rates, nowadays percutaneous gastrostomy is the first method of choice in need of nutrition in patients with functioning gut. In this article authors review the technique of percutaneous radiologic gastrostomy, as well as indications, contraindications, variations of technique, ethical considerations, controversies and comparison with surgical and endoscopic methods.
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