Otolaryngology driven percutaneous endoscopic placement of gastrostomy tubes as part of integrative head and neck cancer service

Background: Percutaneous endoscopic gastrostomy (PEG) placement facilitates nutritional support for head and neck cancer patients with impaired oral intake. The effectiveness of an otolaryngology driven PEG placement and the associated morbidity in an Australian head and neck cancer centre is presented. Methods: A retrospective case series was performed on 96 consecutive head and neck cancer patients who underwent PEG insertion by an otolaryngologists-head and neck (ORL-HN) surgeon within the St. Vincent's head and neck cancer service from 2016 to 2021. Primary outcomes measured included correct placement, and successful function of PEG for enteral nutrition, time to insertion, and concurrent procedures undertaken. Secondary outcomes included morbidity and procedure related mortality within 90 days of the procedure. Results: Successful and correct placement of PEG tube occurred in 100% (n=96). All PEG tubes functioned correctly permitting use. The mean time to insertion was 2.2 +/- 2.6 days. The proportion of PEG tubes inserted with a concurrent procedure was 39%. Major complications occurred in 3 (3%) patients: one solid organ injury, one intra-abdominal abscess and one buried bumper syndrome. There was a total of 6 (6%) minor complications reported; two with transient paralytic ileus, three with peristomal leakage, and one with a rectus sheath haematoma. There were no procedure related mortalities. Conclusions: The effectiveness of an otolaryngology driven PEG placement in an Australian head and neck cancer centre has been described, integrated as part of patient care. Success of insertion and morbidity rates were comparable with previously reported studies of similar populations. Patient and logistical benefits delivered include ability to perform procedures concurrent to PEG insertion and enhanced continuity of care.