Endoscopic feeding tube placement in patients with cancer: a prospective clinical audit of 2055 procedures in 1866 patients

Abstract

Background: Feeding tube placement in patients with aero-digestive cancer is challenging because of the distortion and/or obstruction of the upper digestive passage. As a result, many patients may receive intravenous fluids and parenteral nutrition instead of enteral feeds.

Aim: To audit all the endoscopic feeding tube placements in large sample of patients to determine difficulties, success, reasons for failures and procedure-related complications.

Methods: Audit of all consecutive feeding tube placements from January 1996 to December 2003 was conducted. Tubes were placed depending on the site of cancer and anticipated duration of feeding: naso-gastric tubes, naso-enteral tubes and percutaneous endoscopic gastrostomy. Nutrition support team evaluated these patients. Technical modifications, difficulties, success and complications encountered during the procedure were recorded.

Results: Two thousand and fifty-five attempts were made for feeding tube placements (naso-gastric tube - 1637, naso-enteral tube - 177 and percutaneous endoscopic gastrostomy - 241) in 1866 patients. Technical success was achieved in 1969 (96%, 95% CI: 95-97%). Immediate complications occurred in 62 (3%, 95% CI: 2-4%), seven needed hospitalization and one patient died of tumour perforation caused by naso-gastric tube placement. The technical success and complications rates of the procedures performed by fellows in training were comparable to those performed by attending consultants.

Conclusions: Enteral feeding tubes can be placed in almost all patients with cancer using endoscopic techniques. Adequate training of the endoscopy fellows and sufficient care by nutrition support team help achieve high success with few complications.