Prospective Multicenter long term follow up results of new introducer percutaneous endoscopic gastrostomy method with gastropexy in 89 patients

Aims: Gauderer's pull PEG is the most commonly used method for performing endoscopic gastrostomy, but may not be possible in certain patients with aero-digestive cancers due to distortion of the upper digestive passage. These patients have advanced malignancies, severely malnourished. Also pull PEG may cause tumor seeding at the peristomal site and higher incidence of PEG site infections because of the passage of the inner bumper through oropharynx. To overcome these issues a new introducer technique has been in use, which avoids the sojourn of PEG catheter through the oropharynx. A prospective follow up study was performed to assess the indications, complications, technical difficulties and long term outcome of PEG-gastropexy. This is the largest study reporting the PEG-gastropexy follow up.

Methods: From 05/03–10/07 PEG-gastropexy were placed in 89 selected patients using Freka (Pexact®, Fresenius, Germany) under Propofol sedation. For this, gastric wall was sutured non surgically to the anterior abdominal wall before catheter insertion using an endoscope. Also we could switch to button PEG much earlier (2–4 wks).

Result: PEG placement was successful in all patients. There were 26 females, median age 62yrs. The indications for the procedure were the following malignancies: Oral cavity-23, pharynx- 21, larynx-19, esophageal-18, and tumor metastasia-8. The time required to perform the procedure was 15–120min (avg-20min). 1 patient developed hypoxia during the procedure. 5 patients developed peristomal infection during the follow up. In 3 patients there were technique related complications like breaking of the double needle puncture system in 1 and leakage of gastrostomy balloon in 2. In 12 patients, gastrotube or button PEG were removed as they were able to eat adequately 6–15 months after procedure. The survival was 1–23 months post procedure (avg-5 months). 47 patients died during follow up on PEG feeds.

Conclusion: New introducer PEG Gastropexy technique can be placed safely in almost all patients with obstructing oropharyngeal tumors. This would obviate the need for riskier and more expensive surgical or radiological options in patients in whom pull type PEG is not possible. Long term follow up of the patients revealed only minor complications.