Outpatient percutaneous endoscopic gastrostomy, using traction (Gauderer-Ponsky) and introduction (Russell) methods, in patients with head and neck cancer: randomized clinical trial

INTRODUCTION: The comparison of different percutaneous endoscopic gastrostomy (PEG) techniquesshows that all are equivalent in terms of safety and success rate. Several authors suggest that the method of introduction is associated with lower infection rate than the pull method, because there is no transoral passage of the tube. In the case of patients with head and neck cancer (HNC) it also reduces the risk of metastatic implantation to the puncture site. Despite these considerations, the literature is conflicting when comparing the results. There are only few studies about PEG as an ambulatoryprocedure in HNC outpatients. OBJECTIVES: To compare pull and introduction techniques of PEG inHNC patients on an outpatient basis, regarding success rate, overall complication rate, infection rateand total duration of procedure. MATERIALS AND METHODS: Randomized clinical trial, with a follow-upperiod of 6 months. Among the adult HNC patients refered to PEG at Cancer Hospital I, of the Brazilian National Cancer Institute (HC I / INCA), subjects in good clinical condition were selected to outpatient PEG tube placement by pull or introduction techniques. Primary endpoints were success rate, complications rate and total PEG procedure time. Secondary endpoints were mortality, elective tube removal and PEG tube in use rates at the end of the study.All patients received 20Fr PEG tubes.Statistical analysis was performed using the Student t test and the Chi-squared test, whenappropriate. P values were considered significant when <0.05...