Palliative Venting Gastrostomy in Patients with Malignant Bowel Obstruction and Ascites

Abstract

Background Fluoroscopic-guided placement of a percutaneous decompression gastrostomy tube (PDGT) is used to palliate patients with malignant bowel obstruction (MBO). We report our clinical experience in cases of MBO and ascites that were known to be technically difficult and at increased risk for complications after PDGT placement. Methods Between October 2005 and April 2010, a total of 89 consecutive oncology patients with MBO and ascites underwent at least one attempt at PDGT placement. We retrospectively reviewed the electronic medical record to collect demographic details, procedure information, and morbidity and mortality data. Kaplan–Meier curves were used to calculate median survival after PDGT. Results Ninety-three new gastrostomy encounters occurred in 89 patients. The primary and secondary technical success rates were 72 % (67 of 93) and 77.4 % (72 of 93), respectively. Inadequate gastric distention was the reason for failure in 84.6 % (22 of 26) of the cases in which the initial PDGT attempt was unsuccessful. For ascites management, 13 patients underwent paracentesis and 78 patients underwent placement of an intraperitoneal catheter. The overall complication rate in successful placements was 13.9 %, with a major complication rate of 9.7 %. After PDGT, the median overall survival rate was 28.5 days (95 % confidence interval 20–42). Conclusions PDGT is feasible in the majority of patients with MBO and ascites, although there is an inherent risk of major complications. An intraperitoneal catheter can be used to manage ascites to facilitate PDGT.

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

“…In most patients, routine flushing, changes of position and adequate oral intake of fluids led to improved drainage. Ascites is known to cause several complications due to an insufficient accretion of stomach to skin [11,16]. The technical success rate of 99% in our study lies amid the reports of previous research (86-100%) [7-15, 20, 21] and was not affected by the presence or volume of ascites.…”

“…Previous studies on percutaneous gastrostomies in patients with MBO focus on technical success rates, safety, general outcome and survival [7][8][9][10][11][12][13][14][15][16]. The associated alleviation of symptoms has often been stated, but has not yet been investigated in detail [7][8][9][10][11][12][13].…”

Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer

“…Reported complication rates vary depending on indication, however, in general, major complications, which require readmission or surgical revision, were reported in 2–23% and minor complications in 8–65% [13–15]. Our complication rates fall within these ranges and, interestingly, half may have been prevented with proper diet and maintenance by patients/caregivers.…”

Neutrophil extracellular traps sequester circulating tumor cells and promote metastasis

“…First, manipulation of the primary tumor during surgery is associated with increased numbers of circulating tumor cells (CTCs) (9). Second, infectious complications occur as a result of cancer progression itself, such as bowel obstruction or pneumonia (10,11), and due to complications of standard cancer treatments, such as chemotherapy and surgery (12)(13)(14).…”