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The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient.
JPEN J Parenter Enteral Nutr. 2009 Jul-Aug; 33(4):404-10.JJ

Abstract

BACKGROUND

Chemoradiation of head and neck cancer induces severe dysphagia and malnutrition, which may lead to interruptions in therapy and reduction in its efficacy. Percutaneous endoscopic gastrostomy (PEG) feedings bypass the oropharynx, allowing administration of nutrients and medications into the stomach, thus preventing malnutrition, dehydration, and treatment interruption.

METHODS

Medical records of 161 patients treated for head and neck cancer who had PEGs placed prior to chemoradiation and 2 PEGs placed during chemoradiation were reviewed from the date of PEG placement throughout treatment and utilization. The objective was to determine the contribution of pretreatment PEGs to the therapy of patients with head and neck cancer and to optimize their body mass index.

RESULTS

Severe chemoradiation-induced dysphagia developed in 160 patients (98%), necessitating PEG utilization for feeding and hydration. PEGs were used for a mean 251 +/- 317 days. Significant complications related to PEG placement and utilization were infrequent. PEG feeding allowed chemoradiation to continue without interruption in 93% of patients. Individualized feeding regimens optimized body mass index in obese and overweight patients with a decline from 33.0 +/- 3.4 to 28.4 +/- 4.8 kg/m(2) (P < .001) and 27.3 +/- 1.5 to 24.6 +/- 2.7 kg/m(2) (P < .001), respectively. Radiation-induced strictures developed in 12% of patients, requiring endoscopic dilatation.

CONCLUSIONS

Enteral feeding through prechemoradiation-placed PEGs is an effective and safe method for nutrition and hydration of patients with head and neck cancer undergoing chemoradiation. PEGs allowed chemoradiation to proceed with minimal interruptions despite severe dysphagia, which excluded oral intake for prolonged periods.

Authors+Show Affiliations

Department of Medicine, Columbia University College of Physician & Surgeons, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19520799

Citation

Raykher, Aleksandra, et al. "The Role of Pretreatment Percutaneous Endoscopic Gastrostomy in Facilitating Therapy of Head and Neck Cancer and Optimizing the Body Mass Index of the Obese Patient." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 33, no. 4, 2009, pp. 404-10.
Raykher A, Correa L, Russo L, et al. The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient. JPEN J Parenter Enteral Nutr. 2009;33(4):404-10.
Raykher, A., Correa, L., Russo, L., Brown, P., Lee, N., Pfister, D., Gerdes, H., Shah, J., Kraus, D., Schattner, M., & Shike, M. (2009). The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient. JPEN. Journal of Parenteral and Enteral Nutrition, 33(4), 404-10. https://doi.org/10.1177/0148607108327525
Raykher A, et al. The Role of Pretreatment Percutaneous Endoscopic Gastrostomy in Facilitating Therapy of Head and Neck Cancer and Optimizing the Body Mass Index of the Obese Patient. JPEN J Parenter Enteral Nutr. 2009 Jul-Aug;33(4):404-10. PubMed PMID: 19520799.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of pretreatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient. AU - Raykher,Aleksandra, AU - Correa,Lilia, AU - Russo,Lianne, AU - Brown,Pat, AU - Lee,Nancy, AU - Pfister,David, AU - Gerdes,Hans, AU - Shah,Jatin, AU - Kraus,Dennis, AU - Schattner,Mark, AU - Shike,Moshe, PY - 2009/6/13/entrez PY - 2009/6/13/pubmed PY - 2009/8/8/medline SP - 404 EP - 10 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 33 IS - 4 N2 - BACKGROUND: Chemoradiation of head and neck cancer induces severe dysphagia and malnutrition, which may lead to interruptions in therapy and reduction in its efficacy. Percutaneous endoscopic gastrostomy (PEG) feedings bypass the oropharynx, allowing administration of nutrients and medications into the stomach, thus preventing malnutrition, dehydration, and treatment interruption. METHODS: Medical records of 161 patients treated for head and neck cancer who had PEGs placed prior to chemoradiation and 2 PEGs placed during chemoradiation were reviewed from the date of PEG placement throughout treatment and utilization. The objective was to determine the contribution of pretreatment PEGs to the therapy of patients with head and neck cancer and to optimize their body mass index. RESULTS: Severe chemoradiation-induced dysphagia developed in 160 patients (98%), necessitating PEG utilization for feeding and hydration. PEGs were used for a mean 251 +/- 317 days. Significant complications related to PEG placement and utilization were infrequent. PEG feeding allowed chemoradiation to continue without interruption in 93% of patients. Individualized feeding regimens optimized body mass index in obese and overweight patients with a decline from 33.0 +/- 3.4 to 28.4 +/- 4.8 kg/m(2) (P < .001) and 27.3 +/- 1.5 to 24.6 +/- 2.7 kg/m(2) (P < .001), respectively. Radiation-induced strictures developed in 12% of patients, requiring endoscopic dilatation. CONCLUSIONS: Enteral feeding through prechemoradiation-placed PEGs is an effective and safe method for nutrition and hydration of patients with head and neck cancer undergoing chemoradiation. PEGs allowed chemoradiation to proceed with minimal interruptions despite severe dysphagia, which excluded oral intake for prolonged periods. SN - 0148-6071 UR - https://www.unboundmedicine.com/medline/citation/19520799/The_role_of_pretreatment_percutaneous_endoscopic_gastrostomy_in_facilitating_therapy_of_head_and_neck_cancer_and_optimizing_the_body_mass_index_of_the_obese_patient_ L2 - https://doi.org/10.1177/0148607108327525 DB - PRIME DP - Unbound Medicine ER -