Direct percutaneous endoscopic gastrostomy for nutritional support in patients with aerodigestive tract cancers

Abstract Background Conventional pull‐through percutaneous endoscopic gastrostomy (PEG) risks infection and tumour implantation in head and neck cancers. Endoscopically inserted direct gastrostomy has lower rates of complications but is underutilised. Aims To describe the endoscopic steps for direct gastrostomy insertion and review our single‐centre 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 tumour 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 (87%) of 30 cases were performed under conscious sedation over a median procedure time of 21 min (interquartile range 11 min). No tumour 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.