Percutaneous endoscopic gastrostomy as a method of enteral feeding in children with head and neck masses at the stage of surgical treatment

Percutaneous endoscopic gastrostomy (PEG) is a minimally invasive technique to provide long-term enteral nutrition,which is especially relevant in cases of impossibility to perform adequate oral feeding. Gastrostomy is the method ofchoice for enteral feeding in patients with head and neck tumors.Purpose of the study: to investigate the capabilities of enteral nutrition (EN) after gastrostomy (GN) by analyzing the dataobtained for children with head and neck masses.
Material and Methods. The study included 41 patients, including 20 males aged from 2 months to 16 years with amedian age of 7 years. Inclusion criteria: head/neck tumor after surgical intervention, PEG performed, anthropometrydata available for the day PEG and for days 30, 60, 100 and 180 after, nutritionist consultation immediately before PEGand/or within 10 days after, follow-up in our center for at least 6 months after PEG.Most children (18/43.9%) were diagnosed with severe protein and energy undernutrition (PEU), with moderate PEU foundin 7 (17.0%), mild PEU in 6 (14.6%), and normal nutritional status in 10 (24.4%) children. Most children (29/70.7%) receivednutritional support (NS) before gastrostomy. A retrospective analysis was performed.Results. Parenteral nutrition (PN) was received by 18 (43,9%) patients. On the background of enteral feeding using GS,it became possible to discontinue PN in most patients (the number of patients receiving PN was reduced by 50% by the2nd month after gastrostomy, and up to 5% by the 4th month). At month 6, 12% of patients required PN. In most patients,optimal enteral feeding was achieved at months 4-5, and most patients could not receive EF even at the level coveringbasal metabolism in the first weeks after gastrostomy. In most patients, the dynamics of body mass index was positive,especially noticeable by day 60 after gastrostomy, but it was primarily due to adipose mass gain, while muscle mass hadmore modest dynamics.
Conclusion. PEG allows to reduce the demand or completely avoid PN (but not in all patients in our case). Not all patientscan assimilate the calculated volume of EF, time and selection of the nutritive support is required. Nutritional monitoringof patients receiving EF via GS is necessary, as adequate and timely adjustment of the nutrition is required. Rapid weightgain, including in undernourished patients, is not a guarantee of rapid muscle gain. It is advisable to analyze the adiposemass, if possible. In studies of gastrostomy efficacy, it is reasonable to take into account not the fact of gastrostomyitself, but the nutritive support conducted via the tube (and the possibility to conduct it), tolerability of this support and itsassimilation by the patient.
Keywords: head and neck tumors, gastrostomy, nutritional support