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首页> 外文期刊>Surgical Endoscopy >Gastrocutaneous fistulas after PEG removal in adult cancer patients: frequency and treatment options
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Gastrocutaneous fistulas after PEG removal in adult cancer patients: frequency and treatment options

机译：PEG在成人癌症患者中去除后的胃皮瘘：频率和治疗选择

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Introduction and aims PEG removal in head and neck cancer patients (HNCPs) is performed after treatment, in case of disease remission and after adequate oral intake is resumed. The PEG tract usually closes spontaneously within 2-3 days. Persistent gastrocutaneous fistula (GCF) is a rare complication after PEG tube removal and is characterized by the persistence of gastric leakage through the fistulous tract for more than 1 month. Our main goal was to access the incidence and the success of a treatment algorithm for GCF in HNCPs. Methods Retrospective unicentric study of HNCPs referred for PEG removal between 2014 and 2018. The patients with GCF were selected and their sequential treatment was reviewed. Results In 331 patients with PEGs removed, 19 (5.7%) GCFs were documented. Medical therapy (4-8 weeks) was performed with clinical success (definitive closure of the GCF) in 12 (63.2%) patients. The remaining seven patients required endoscopic or surgical treatment. In four, endoscopic treatment had technical and clinical success (in three patients with fulguration of the gastric leak edges with argon plasma coagulation, silver nitrate in the path and external orifice, and closure of the internal orifice with hemoclips and in one with an over-the-scope-clip). Only three patients underwent surgery, one due to clinical failure of sequential endoscopic therapy and two had direct surgery. Conclusion GCF occurs rarely after PEG removal in HNCPs. Medical therapy is usually effective and should be maintained for at least 8 weeks. Endoscopic therapy is an effective second-line option with and surgery rarely required.
机译：引言和目的头颈癌患者（HNCPs）的PEG去除是在治疗后进行的，以防病情缓解，并在恢复足够的口服摄入后进行。PEG束通常在2-3天内自发闭合。持续性胃皮肤瘘（GCF）是PEG管移除后的一种罕见并发症，其特征是通过瘘道持续胃漏超过1个月。我们的主要目标是了解HNCPs中GCF治疗算法的发生率和成功率。方法回顾性单中心研究2014年至2018年间HNCPs去除PEG的情况。选择GCF患者并回顾其序贯治疗。结果在331例PEG移除患者中，有19例（5.7%）GCF被记录。对12名（63.2%）患者进行了药物治疗（4-8周），取得了临床成功（GCF最终闭合）。其余7名患者需要内镜或手术治疗。在四名患者中，内镜治疗在技术和临床上都取得了成功（三名患者采用氩离子凝固术对胃漏边缘进行了电灼，硝酸银在通道和外部孔口进行了电灼，并用止血夹封闭了内部孔口，一名患者使用了超范围夹）。只有三名患者接受了手术，其中一名患者由于序贯内镜治疗的临床失败，两名患者直接接受了手术。结论HNPS去除PEG后很少发生GCF。药物治疗通常是有效的，应至少维持8周。内镜治疗是一种有效的二线选择，很少需要手术。

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