Push-type percutaneous endoscopic gastrostomy with ultrathin endoscope in patients with severe trismus or obstruction due to head and neck cancers: A case series

Aim:  Endoscopically-placed, push-type percutaneous endoscopic gastrostomies (PEG) have recently been made possible through the use of a gastropexy device. However, the safety and efficacy of the procedure in patients suffering from severe trismus or malignant obstruction due to head and neck cancers have rarely been reported. The aim of this study was thus to investigate the feasibility, safety and risk of endoscopic push-type PEG in this group of patients. Patients and Methods:  Consecutive patients who were indicated for PEG and suffered from severe trismus or malignant obstruction due to head and neck cancers, precluding the introduction of a 9.8 mm oesophagogastroduodenoscope were included. Push-type PEG was performed under endoscopic control with a 5-mm endoscope and the loop fixture device. Results:  Eleven patients had push-type PEG performed under conscious sedation. All procedures were successful, and minor complications occurred in one patient with a dislodged gastrostomy tube and another with wound infection. There were no mortalities or major morbidities related to the procedure. Conclusions:  Push-type PEG with gastropexy inserted under endoscopic control by an ultrathin endoscope is a feasible alternative to open gastrostomy in patients with severe trismus or pharyngeal obstruction.