Inserting a percutaneous endoscopic gastrostomy tube via a cervical fistula formed after major surgery on a patient with a head and neck tumor

Abstract

Several percutaneous endoscopic gastrostomy techniques have been devised so far to provide enteral nutrition for patients with head and neck cancer, because no single technique is adequate for all. Anatomic and functional deficits caused by advanced tumor extension or by surgery or irradiation often hinder traditional peroral gastroscopy. Transnasal, laryngoscopically guided, or intraoperative gastroscopic procedures are useful technical methods for percutaneous endoscopic gastrostomy placement. This article introduces a new method of gastroscopy, as yet unpublished. After total laryngectomy and partial pharyngectomy, the remaining narrow hypopharyngeal lumen often is insufficient for peroral gastroscopy. However, coexisting cervical pharyngocutaneous fistula can provide an approach and route for percutaneous endoscopic gastrostomy. The procedure was carried out successfully with no complications.