Outpatient Percutaneous Radiologic Gastrostomy in Patients With Head and Neck Tumors
Outpatient Percutaneous Radiologic Gastrostomy in Patients With Head and Neck Tumors
This study intends to evaluate the security and success rate of large bore percutaneous
 radiologic gastrostomy in patients with head and neck tumors, as a outpatient procedure.
Percutaneous gastrostomy is a procedure that intends to provide prolonged alimentary access
 to patients with normal gastrointestinal tract, which are unable to eat or are facing
 troubles with deglutition.

 Nowadays it is considered as the first line procedure to prolonged enteral access on this
 patients.

 The indications to perform a percutaneous gastrostomy in a cancer center are usually related
 to head and neck, central nervous system and esophagus tumors. In our institution around 80%
 of the percutaneous gastrostomy are performed in patients with head an neck tumors.

 Although percutaneous gastrostomy is considered a safe procedure, there are some
 complications related, specially in oncologic patients. Those complications are reported in
 about 40% of the cases.

 Percutaneous gastrostomy is usually performed as a inpatient procedure, which leads to
 hospitalization costs. However, some studies have shown that is safe and viable to perform
 percutaneous gastrostomy (both endoscopic or radiologic), as a outpatient procedure, in
 patients with head a neck tumors.

 As both techniques (endoscopic and radiologic) present similar results, patients treated in
 our institution that require a percutaneous gastrostomy are referred to endoscopic and
 interventional radiology departments.

 Some of these patients are selected to undergo an outpatient procedure, based on social and
 clinical criteria.

 The majority of the available data shows that both the endoscopic and the radiologic
 techniques present similar results in terms of security and rate of precocious and late
 complications, and that both are superior than the surgical technique, considering they are
 least invasive and related with lower rates of complication and costs.

 In the present, the traction (Gauderer-Ponsky) technique is the most widely used in our
 institution for the endoscopic procedure.

 In the interventional radiology department the percutaneous gastrostomy is performed using
 the introduction (Russel) technique, in which a guidewire is positioned after the stomach
 needle puncture, made under ultrasound or fluoroscopic guidance. After that, the tract is
 progressively dilated to allow the introduction of the gastrostomy balloon catheter, through
 the abdominal wall, using a peel-away sheath.

 This same technique can be performed for the endoscopic gastrostomy, using the same
 gastrostomy kit, but under endoscopic guidance.

 Some authors suggest that the introduction technique, although more challenging, is
 associated with less stoma infections, because is the only one that is not associated with
 oral catheterization.

 For the patients with head an neck tumors, there is also a reduced risk of metastases
 implants on the puncture site.

 Besides those considerations, the data available is still not consensual.
Inclusion Criteria:

 -  Surgical risk ASA I-III, Karnofsky Performance Status >70, acceptance and
 comprehension of the orientations and after-care, adequate social a familiar support,
 easy access to the hospital.

 Exclusion Criteria:

 -  patients who live more than one hour away from the hospital, coagulopathies, refuse to
 join the protocol.