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Transcervical approach to percutaneous endoscopic gastrostomy tube insertion in a patient with head and neck cancer
Author(s) -
Shariff Amir Hafeez,
Waqas Muhammad,
Akhtar Shabbir
Publication year - 2014
Publication title -
asian journal of endoscopic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.372
H-Index - 18
eISSN - 1758-5910
pISSN - 1758-5902
DOI - 10.1111/ases.12104
Subject(s) - medicine , surgery , percutaneous endoscopic gastrostomy , trismus , head and neck cancer , gastrostomy , endoscopy , peg ratio , radiation therapy , finance , economics
Abstract This is the case of a 48‐year‐old woman with recurrent head and neck cancer. Six years before presenting at our institution, she was diagnosed with a moderately differentiated squamous cell carcinoma involving the right maxilla and underwent surgical resection followed by chemoradiation. More recently, she presented at our institution with oral bleeding and pain. Examination revealed severe trismus, and biopsy demonstrated recurrent squamous cell carcinoma. She underwent surgical resection with a plan for simultaneous placement of a feeding gastrostomy tube. Owing to the near non‐existent mouth opening, traditional per‐oral placement of a percutaneous endoscopic gastrostomy ( PEG ) tube was impossible. Intraoperatively, following tumor resection, endoscopy was performed via direct pharyngeal access through a right cervical incision. The PEG tube was then placed uneventfully. Numerous studies have shown the superiority of PEG tubes over either radiologically or surgically placed gastrostomy tubes. This report describes an approach to PEG placement in a patient in whom per‐oral placement was not feasible.