Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction

Dittrich, Anne T. M.; Schubert, Barbara; Kramer, Michael; Lenz, Felicitas; Kast, Karin; Schuler, Ulrich S.; Schüler, Markus

doi:10.1007/s00520-017-3700-1

Cited by 29 publications

(30 citation statements)

References 19 publications

(48 reference statements)

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“…10,13 However, a recent study found that ascites was not significant for the development of infective complications, but it is an independent risk factor for stomal leakage and insufficient drainage. 15 It also found no association between ascites and technical success of the procedure. 15 Overall, it appears that the presence of ascites should not be considered an absolute contraindication for insertion of percutaneous drainage gastrostomy tube to relieve MBO, even though there is a slightly higher chance of minor complications such as stomal leakage postprocedure in these patients.…”

Section: Discussionmentioning

confidence: 92%

“…These studies indicate that drainage percutaneous gastrostomy tubes can technically be placed despite the presence of ascites in patients with MBO; however, longitudinal outcomes and complications are lacking (Table 2). 9,10,[12][13][14][15][16][17][18]23,24,26,28 Although the majority did not drain the ascites, some studies advocate predrainage of ascites to facilitate insertion and prevent associated complications. 12,13,16 One study found no association between the presence of ascites and survival.…”

Section: Discussionmentioning

confidence: 99%

“…13 Peritonitis was reported in 12 patients, and 1 case of yeast sepsis due to an obstructed tube was reported. [12][13][14][15][16][17][18] One study reported a spontaneous dislodgement of a PEG, which required a minilaparotomy to retrieve the gastrostomy tube. 19 One case of pneumo-peritonitis was reported, while in one of the earliest studies, there was one case of leakage of gastric juices causing autodigestion of abdominal wall despite replacement tube with larger catheters.…”

Section: Majormentioning

confidence: 99%

“…8,9,13,[15][16][17][18]20,[22][23][24][25] Minor site (peristomal/wound) infections occurred in 61 (5.1%) patients. [7][8][9][10][11][12][13]15,17,19,20,23,24,26 Minor bleeding from the site was reported in 6 patients. 8,9,17 Intermittent obstruction or blockage of tube occurred in 33 (2.8%) patients, while 25 (2.1%) cases of tube dislodgement were reported.…”

Section: Minormentioning

confidence: 99%

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Safety and Efficacy of Venting Gastrostomy in Malignant Bowel Obstruction: A Systematic Review

et al. 2019

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Malignant bowel obstruction (MBO) is a common manifestation in patients with advanced intra-abdominal malignancy. It is especially common with bowel or gynecological cancers and produces distressing symptoms, including nausea, vomiting, and pain. Medical management options are less effective than decompressive strategies for symptom control. Surgery is the gold-standard treatment but is unsuitable for most patients with high complication rates. Consensus guidelines recommend nonsurgical management with a venting gastrostomy in those unsuitable for surgery or for whom medical management is ineffective. The aim of this systematic review is to establish the safety and efficacy of percutaneous venting gastrostomy in relieving symptoms of MBO. Twenty-five studies were included in this review comprising 1194 patients. Gastrostomy insertion was successful at first attempt in 91% of cases and reduction in symptoms of nausea and vomiting was reported in 92% of cases. Mean survival following the procedure ranged from 35 to 147 days. Major complications were rare, with most complications classed as minor wound infections or leakage of fluid around the tube. Studies suggest that the presence of ascites is not an absolute contraindication to the insertion of percutaneous venting gastrostomy in patients with MBO; however, these studies lack longitudinal outcomes and complication rates related to this. However, it is reasonable to suggest that ascitic drainage is performed to reduce potential complications. There is a relative lack of good quality robust data on the utilization of percutaneous venting gastrostomy in MBO, but overall, the combination of being a safe and efficacious procedure alongside the known complication profile suggests that it should be considered a suitable management option.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Majormentioning

confidence: 99%

Section: Minormentioning

confidence: 99%

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Safety and Efficacy of Venting Gastrostomy in Malignant Bowel Obstruction: A Systematic Review

et al. 2019

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“…Backward migration to the stomach is a common event, which may be reduced if the tip is initially placed beyond the ligament of Treitz [20]. In order to reduce repeated manipulation and the risk of gastric migration of the jejunal tube, the connection of a drainage PEG to the feeding PEG-J was proposed for GOO patients [42,43].…”

Section: Peg With Jejunal Extension Andmentioning

confidence: 99%

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

Nunes

Fonseca

Barata

et al. 2019

GE Port J Gastroenterol

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Background: Digestive tumours are among the leading causes of morbidity and mortality. Many cancer patients cannot maintain oral feeding and develop malnutrition. The authors aim to: review the endoscopic, radiologic and surgical techniques for nutritional support in cancer patients; address the strategies for nutritional intervention according to the selected technique; and establish a decision-making algorithm to define the best approach in a specific tumour setting. Summary: This is a narrative non-systematic review based on an electronic search through the medical literature using PubMed and UpToDate. The impossibility of maintaining oral feeding is a major cause of malnutrition in head and neck (H&N) cancer, oesophageal tumours and malignant gastric outlet obstruction. Tube feeding, endoscopic stents and gastrojejunostomy are the three main nutritional options. Nasal tubes are indicated for short-term enteral feeding. Percutaneous endoscopic gastrostomy (PEG) is the gold standard when enteral nutrition is expected for more than 3-4 weeks, especially in H&N tumour and oesophageal cancer patients undergoing definite chemoradiotherapy. A gastropexy push system may be considered to avoid cancer seeding. Radiologic and surgical gastrostomy are alternatives when an endoscopic approach is not feasible. Postpyloric nutrition is indicated for patients intolerant to gastric feeding and may be achieved through nasoenteric tubes, PEG with jejunal extension, percutaneous endoscopic jejunostomy and surgical jejunostomy. Oesophageal and enteric stents are palliative techniques that allow oral feeding and improve quality of life. Surgical or EUS-guided gastrojejunostomy is recommended when enteric stents fail or prolonged survival is expected. Nutritional intervention is dependent on the technique chosen. Institutional protocols and decision algorithms should be developed on a multidisciplinary basis to optimize nutritional care. Conclusions: Gastroenterologists play a central role in the nutritional support of cancer patients performing endoscopic techniques that maintain oral or enteral feeding. The selection of the most effective technique must consider the cancer type, the oncologic therapeutic program, nutritional aims and expected patient survival.

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The Chicago Consensus on peritoneal surface malignancies: Palliative care considerations

Plana¹,

Izquierdo²,

Schuitevoerder³

et al. 2020

Cancer

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The Chicago Consensus Working Group provides multidisciplinary recommendations for palliative care specifically related to peritoneal surface malignancies. These guidelines are developed with input from leading experts including surgical oncologists, medical oncologists, gynecologic oncologists, pathologists, radiologists, palliative care physicians, and pharmacists. These guidelines recognize and address the emerging need for increased awareness in the appropriate management of peritoneal surface disease. They are not intended to replace the quest for higher levels of evidence. Cancer 2020;126:2571-2576.Octreotide is a synthetic peptide mimicking the natural effects of somatostatin, thereby reducing gastrointestinal secretions and gastrointestinal motility. In multiple studies, octreotide has been demonstrated to reduce vomiting episodes and gastrointestinal symptoms. 17,18 In addition, quality-of-life scores have improved with the use of octreotide in nonrandomized clinical studies. 19,20 When compared with anticholinergic therapies,

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Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction

Cited by 29 publications

References 19 publications

Safety and Efficacy of Venting Gastrostomy in Malignant Bowel Obstruction: A Systematic Review

Safety and Efficacy of Venting Gastrostomy in Malignant Bowel Obstruction: A Systematic Review

Nutritional Support of Cancer Patients without Oral Feeding: How to Select the Most Effective Technique?

The Chicago Consensus on peritoneal surface malignancies: Palliative care considerations

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