Background

Conventional pull-through PEG risks infection and tumor implantation in head and neck cancers. Endoscopically inserted direct gastrostomy has lower rates of complications but is under-utilized.

Aims

To describe the endoscopic steps for direct gastrostomy insertion and review our single-center experience to assess the technical feasibility and safety.

Methods

Patients who underwent endoscopic direct gastrostomy insertion between December 2016 and June 2021 were included. A 24Fr introducer kit for gastrostomy feeding tube (Avanos Healthcare, Australia) was used. Patient and tumor characteristics, procedural data and 30-day outcomes were recorded.

Results

Thirty patients underwent direct PEG insertion (mean age 64 years and 24 male). All were planned for or currently undergoing radiotherapy. Twenty-six cases were performed under conscious sedation (26/30, 87%) over a median procedure time of 21 min (interquartile range 11 min). No tumor seeding was seen, and one case of PEG-site infection was observed.

Conclusions

Direct PEG is safe and effective and should be considered for patients with aerodigestive tract cancer in need of nutritional support.

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