Percutaneous Endoscopic Gastrostomy before Multimodality Therapy in Patients with Esophageal Cancer

Marc Margolis, Pendleton Alexander, Gregory D. Trachiotis, Farid - Gharagozloo, Timothy Lipman, Darryl S. Weiman, Daniel L. Miller, Joe B. Putnam

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background. Percutaneous endoscopic gastrostomy (PEG) has not been widely used in esophageal cancer because of concerns about safety of dilatation, suitability of the stomach as an esophageal replacement, and potential for inoculation metastasis. Methods. Experience with PEG in consecutive patients presenting with new esophageal cancer from March 1991 to March 2001 was reviewed retrospectively. PEG was planned in 119 of 179 (66%) of these patients excluding those presenting moribund and those for whom early resection was planned. The PEG was placed using an endoscopic method with wire-guided endoscopic bougienage or laser ablation or both as needed. Success of placement, requirement for dilatation and ablation, PEG-related complications, tolerance of enteral feeds, and impact on therapy were evaluated. Results. PEG placement was possible in 87% of patients (103 of 119). Dilatation or laser ablation or both was required in 46% (47 of 103). There was no procedure-related mortality. Thirty-day mortality was 13.5%. Major PEG-related complications were observed in 4% (4 of 103) and minor PEG-related complications in 12% (12 of 103). PEG removal was required in 4 patients and interruption of enteral feeds required in 33 (32%). No instances of esophageal disruption or tumor inoculation metastasis were noted. PEG takedown and site closure at the time of operation was uncomplicated and use of the stomach as an esophageal substitute was possible in all 61 resected patients. Rates of anastomotic leak, stricture, and gastric emptying delay were similar to those for patients proceeding to resection without prior PEG (leak: PEG = 8% [5 of 61] versus non-PEG = 10.5% [2 of 19]), (stricture: PEG = 37% [22 of 61] versus non-PEG = 32.5% [6 of 19]), (delay: PEG = 9.8% [6 of 61] versus non-PEG = 10.5% [2 of 19]). Analysis of variables showed PEG to be significantly related to attainment of target doses of chemoradiotherapy (p = 0.034), and survival at 12 months (p = 0.02). Conclusions. PEG in esophageal cancer is safe and useful and does not compromise the stomach or esophagogastric anastomosis. Further study is required to define the efficacy of PEG as a means of nutritional support and its impact on survival.

Original languageEnglish (US)
Pages (from-to)1694-1698
Number of pages5
JournalAnnals of Thoracic Surgery
Volume76
Issue number5
DOIs
StatePublished - Nov 2003
Externally publishedYes

Fingerprint

Gastrostomy
Esophageal Neoplasms
Therapeutics
Laser Therapy
Small Intestine
Dilatation
Stomach
Pathologic Constriction
Gastric Dilatation
Neoplasm Metastasis
Anastomotic Leak

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Percutaneous Endoscopic Gastrostomy before Multimodality Therapy in Patients with Esophageal Cancer. / Margolis, Marc; Alexander, Pendleton; Trachiotis, Gregory D.; Gharagozloo, Farid -; Lipman, Timothy; Weiman, Darryl S.; Miller, Daniel L.; Putnam, Joe B.

In: Annals of Thoracic Surgery, Vol. 76, No. 5, 11.2003, p. 1694-1698.

Research output: Contribution to journalArticle

Margolis, M, Alexander, P, Trachiotis, GD, Gharagozloo, F, Lipman, T, Weiman, DS, Miller, DL & Putnam, JB 2003, 'Percutaneous Endoscopic Gastrostomy before Multimodality Therapy in Patients with Esophageal Cancer', Annals of Thoracic Surgery, vol. 76, no. 5, pp. 1694-1698. https://doi.org/10.1016/S0003-4975(02)04890-7
Margolis, Marc ; Alexander, Pendleton ; Trachiotis, Gregory D. ; Gharagozloo, Farid - ; Lipman, Timothy ; Weiman, Darryl S. ; Miller, Daniel L. ; Putnam, Joe B. / Percutaneous Endoscopic Gastrostomy before Multimodality Therapy in Patients with Esophageal Cancer. In: Annals of Thoracic Surgery. 2003 ; Vol. 76, No. 5. pp. 1694-1698.
@article{0a9489a4e27b43258de9782631327d13,
title = "Percutaneous Endoscopic Gastrostomy before Multimodality Therapy in Patients with Esophageal Cancer",
abstract = "Background. Percutaneous endoscopic gastrostomy (PEG) has not been widely used in esophageal cancer because of concerns about safety of dilatation, suitability of the stomach as an esophageal replacement, and potential for inoculation metastasis. Methods. Experience with PEG in consecutive patients presenting with new esophageal cancer from March 1991 to March 2001 was reviewed retrospectively. PEG was planned in 119 of 179 (66{\%}) of these patients excluding those presenting moribund and those for whom early resection was planned. The PEG was placed using an endoscopic method with wire-guided endoscopic bougienage or laser ablation or both as needed. Success of placement, requirement for dilatation and ablation, PEG-related complications, tolerance of enteral feeds, and impact on therapy were evaluated. Results. PEG placement was possible in 87{\%} of patients (103 of 119). Dilatation or laser ablation or both was required in 46{\%} (47 of 103). There was no procedure-related mortality. Thirty-day mortality was 13.5{\%}. Major PEG-related complications were observed in 4{\%} (4 of 103) and minor PEG-related complications in 12{\%} (12 of 103). PEG removal was required in 4 patients and interruption of enteral feeds required in 33 (32{\%}). No instances of esophageal disruption or tumor inoculation metastasis were noted. PEG takedown and site closure at the time of operation was uncomplicated and use of the stomach as an esophageal substitute was possible in all 61 resected patients. Rates of anastomotic leak, stricture, and gastric emptying delay were similar to those for patients proceeding to resection without prior PEG (leak: PEG = 8{\%} [5 of 61] versus non-PEG = 10.5{\%} [2 of 19]), (stricture: PEG = 37{\%} [22 of 61] versus non-PEG = 32.5{\%} [6 of 19]), (delay: PEG = 9.8{\%} [6 of 61] versus non-PEG = 10.5{\%} [2 of 19]). Analysis of variables showed PEG to be significantly related to attainment of target doses of chemoradiotherapy (p = 0.034), and survival at 12 months (p = 0.02). Conclusions. PEG in esophageal cancer is safe and useful and does not compromise the stomach or esophagogastric anastomosis. Further study is required to define the efficacy of PEG as a means of nutritional support and its impact on survival.",
author = "Marc Margolis and Pendleton Alexander and Trachiotis, {Gregory D.} and Gharagozloo, {Farid -} and Timothy Lipman and Weiman, {Darryl S.} and Miller, {Daniel L.} and Putnam, {Joe B.}",
year = "2003",
month = "11",
doi = "10.1016/S0003-4975(02)04890-7",
language = "English (US)",
volume = "76",
pages = "1694--1698",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Percutaneous Endoscopic Gastrostomy before Multimodality Therapy in Patients with Esophageal Cancer

AU - Margolis, Marc

AU - Alexander, Pendleton

AU - Trachiotis, Gregory D.

AU - Gharagozloo, Farid -

AU - Lipman, Timothy

AU - Weiman, Darryl S.

AU - Miller, Daniel L.

AU - Putnam, Joe B.

PY - 2003/11

Y1 - 2003/11

N2 - Background. Percutaneous endoscopic gastrostomy (PEG) has not been widely used in esophageal cancer because of concerns about safety of dilatation, suitability of the stomach as an esophageal replacement, and potential for inoculation metastasis. Methods. Experience with PEG in consecutive patients presenting with new esophageal cancer from March 1991 to March 2001 was reviewed retrospectively. PEG was planned in 119 of 179 (66%) of these patients excluding those presenting moribund and those for whom early resection was planned. The PEG was placed using an endoscopic method with wire-guided endoscopic bougienage or laser ablation or both as needed. Success of placement, requirement for dilatation and ablation, PEG-related complications, tolerance of enteral feeds, and impact on therapy were evaluated. Results. PEG placement was possible in 87% of patients (103 of 119). Dilatation or laser ablation or both was required in 46% (47 of 103). There was no procedure-related mortality. Thirty-day mortality was 13.5%. Major PEG-related complications were observed in 4% (4 of 103) and minor PEG-related complications in 12% (12 of 103). PEG removal was required in 4 patients and interruption of enteral feeds required in 33 (32%). No instances of esophageal disruption or tumor inoculation metastasis were noted. PEG takedown and site closure at the time of operation was uncomplicated and use of the stomach as an esophageal substitute was possible in all 61 resected patients. Rates of anastomotic leak, stricture, and gastric emptying delay were similar to those for patients proceeding to resection without prior PEG (leak: PEG = 8% [5 of 61] versus non-PEG = 10.5% [2 of 19]), (stricture: PEG = 37% [22 of 61] versus non-PEG = 32.5% [6 of 19]), (delay: PEG = 9.8% [6 of 61] versus non-PEG = 10.5% [2 of 19]). Analysis of variables showed PEG to be significantly related to attainment of target doses of chemoradiotherapy (p = 0.034), and survival at 12 months (p = 0.02). Conclusions. PEG in esophageal cancer is safe and useful and does not compromise the stomach or esophagogastric anastomosis. Further study is required to define the efficacy of PEG as a means of nutritional support and its impact on survival.

AB - Background. Percutaneous endoscopic gastrostomy (PEG) has not been widely used in esophageal cancer because of concerns about safety of dilatation, suitability of the stomach as an esophageal replacement, and potential for inoculation metastasis. Methods. Experience with PEG in consecutive patients presenting with new esophageal cancer from March 1991 to March 2001 was reviewed retrospectively. PEG was planned in 119 of 179 (66%) of these patients excluding those presenting moribund and those for whom early resection was planned. The PEG was placed using an endoscopic method with wire-guided endoscopic bougienage or laser ablation or both as needed. Success of placement, requirement for dilatation and ablation, PEG-related complications, tolerance of enteral feeds, and impact on therapy were evaluated. Results. PEG placement was possible in 87% of patients (103 of 119). Dilatation or laser ablation or both was required in 46% (47 of 103). There was no procedure-related mortality. Thirty-day mortality was 13.5%. Major PEG-related complications were observed in 4% (4 of 103) and minor PEG-related complications in 12% (12 of 103). PEG removal was required in 4 patients and interruption of enteral feeds required in 33 (32%). No instances of esophageal disruption or tumor inoculation metastasis were noted. PEG takedown and site closure at the time of operation was uncomplicated and use of the stomach as an esophageal substitute was possible in all 61 resected patients. Rates of anastomotic leak, stricture, and gastric emptying delay were similar to those for patients proceeding to resection without prior PEG (leak: PEG = 8% [5 of 61] versus non-PEG = 10.5% [2 of 19]), (stricture: PEG = 37% [22 of 61] versus non-PEG = 32.5% [6 of 19]), (delay: PEG = 9.8% [6 of 61] versus non-PEG = 10.5% [2 of 19]). Analysis of variables showed PEG to be significantly related to attainment of target doses of chemoradiotherapy (p = 0.034), and survival at 12 months (p = 0.02). Conclusions. PEG in esophageal cancer is safe and useful and does not compromise the stomach or esophagogastric anastomosis. Further study is required to define the efficacy of PEG as a means of nutritional support and its impact on survival.

UR - http://www.scopus.com/inward/record.url?scp=0242552161&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0242552161&partnerID=8YFLogxK

U2 - 10.1016/S0003-4975(02)04890-7

DO - 10.1016/S0003-4975(02)04890-7

M3 - Article

C2 - 14602314

AN - SCOPUS:0242552161

VL - 76

SP - 1694

EP - 1698

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -