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CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(11): E1411-E1416
DOI: 10.1055/a-2458-9919
Original article

Feasibility and benefit of decompressive percutaneous endoscopic gastrostomy (dPEG) in advanced cancer patients with malignant bowel obstruction

Julia Wanzl
1   Department of Gastroenterology, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
,
Susanne Höfer
2   Department of Gastroenterology, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
,
Tanja Schwamberger
2   Department of Gastroenterology, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
,
Vidan Tadic
2   Department of Gastroenterology, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
,
Anna Muzalyova
3   Department of Digital Medicine, University Hospital Augsburg, Augsburg, Germany (Ringgold ID: RIN39694)
,
Irmtraut Hainsch-Müller
4   Department of Palliative Medicine, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
,
Christoph Aulmann
4   Department of Palliative Medicine, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
,
Helmut Messmann
2   Department of Gastroenterology, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
,
Andreas Probst
2   Department of Gastroenterology, University of Augsburg, Augsburg, Germany (Ringgold ID: RIN26522)
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Abstract

Background and study aims Bowel obstruction is a common complication in advanced cancer patients. Patients are restricted in quality of life (QOL) due to nausea, vomiting, or abdominal pain. Prospective data on the feasibility and benefit of decompressive percutaneous endoscopic gastrostomy (dPEG) are scarce.

Patients and methods Patients suffering from symptomatic bowel obstruction due to advanced cancer were included prospectively in a single-center study when other treatments to eliminate the obstruction were impossible. Patients were given a questionnaire the day before dPEG (d-1) and, if the procedure was successful, the day after (d+1) and 14 days after the procedure (d14). Furthermore, lifetime after dPEG was assessed.

Results 53 patients were included. dPEG was technically feasible in 34 of 53 (64.2%). Significant improvement could be shown for nausea and vomiting when comparing d-1 to d+1 (nausea (P = 0.002), vomiting (P < 0.001)) and when comparing d-1 to d14 (P = 0.021 and P = 0.003, respectively). Comparing d+1 to d14, there was no further improvement. QOL improved significantly from 8.1 (mean) on d-1 to 5.9 (mean) on d+1 (P < 0.001). Median survival after successful dPEG was 27 days (range 2–353).

Conclusions dPEG is an effective method for quickly relieve symptoms of malignant bowel obstruction in advanced cancer patients. However, the technical success rate is limited and needs to be improved. Prospective studies comparing endoscopic and computed tomography-guided procedures are needed to avoid unsuccessful procedures in patients with advanced cancer and limited life expectancy.

Keywords

Endoscopy Upper GI Tract - Malignant strictures - Gastrostomy and PEJ - Endoscopy Lower GI Tract - Colorectal cancer


Publikationsverlauf

Eingereicht: 01. Juli 2024

Angenommen nach Revision: 09. September 2024

Artikel online veröffentlicht:
28. November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Tuca A, Guell E, Martinez-Losada E. et al. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res 2012; 4: 159-169
    CrossrefPubMedSuche in Google Scholar
  • 2 Miller G, Boman J, Shrier I. et al. Small-bowel obstruction secondary to malignant disease: an 11-year audit. Can J Surg 2000; 43: 353-358
    PubMedSuche in Google Scholar
  • 3 Tuca A, Roca R, Sala C. et al. Efficacy of granisetron in the antiemetic control of nonsurgical intestinal obstruction in advanced cancer: a phase II clinical trial. J Pain Symptom Manage 2009; 37: 259-270
    CrossrefPubMedSuche in Google Scholar
  • 4 Ripamonti C. Management of bowel obstruction in advanced cancer. Curr Opin Oncol 1994; 6: 351-357
    CrossrefPubMedSuche in Google Scholar
  • 5 Ripamonti C, Bruera E. Palliative management of malignant bowel obstruction. Int J Gynecol Cancer 2002; 12: 135-143
    CrossrefPubMedSuche in Google Scholar
  • 6 Davis M, Hui D, Davies A. et al. Medical management of malignant bowel obstruction in patients with advanced cancer: 2021 MASCC guideline update. Support Care Cancer 2021; 29: 8089-8096
    CrossrefPubMedSuche in Google Scholar
  • 7 Motta APG, Rigobello MCG, Silveira R. et al. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem 2021; 29: e3400
    CrossrefPubMedSuche in Google Scholar
  • 8 Campagnutta E, Cannizzaro R, Gallo A. et al. Palliative treatment of upper intestinal obstruction by gynecological malignancy: the usefulness of percutaneous endoscopic gastrostomy. Gynecol Oncol 1996; 62: 103-105
    CrossrefPubMedSuche in Google Scholar
  • 9 Soriano A, Davis MP. Malignant bowel obstruction: individualized treatment near the end of life. Cleve Clin J Med 2011; 78: 197-206
    CrossrefPubMedSuche in Google Scholar
  • 10 Gauderer MW, Ponsky JL, Izant RJ. Gastrostomy without laparotomy: a percutaneous endoscopic technique. J Pediatr Surg 1980; 15: 872-875
    CrossrefPubMedSuche in Google Scholar
  • 11 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedSuche in Google Scholar
  • 12 Issaka RB, Shapiro DM, Parikh ND. et al. Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction. Surg Endosc 2014; 28: 1668-1673
    PubMedSuche in Google Scholar
  • 13 Herman LL, Hoskins WJ, Shike M. Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel. Gastrointest Endosc 1992; 38: 314-318
    CrossrefPubMedSuche in Google Scholar
  • 14 Vargo JJ, Germain MM, Swenson JA. et al. Ultrasound-assisted percutaneous endoscopic gastrostomy in a patient with advanced ovarian carcinoma and recurrent intestinal obstruction. Am J Gastroenterol 1993; 88: 1946-1948
    PubMedSuche in Google Scholar
  • 15 Panzer S, Harris M, Berg W. et al. Endoscopic ultrasound in the placement of a percutaneous endoscopic gastrostomy tube in the non-transilluminated abdominal wall. Gastrointest Endosc 1995; 42: 88-90
    CrossrefPubMedSuche in Google Scholar
  • 16 Yasin JT, Schuchardt PA, Atkins N. et al. CT-guided gastrostomy tube placement-a single center case series. Diagn Interv Radiol 2020; 26: 464-469
    CrossrefPubMedSuche in Google Scholar
  • 17 Teriaky A, Gregor J, Chande N. Percutaneous endoscopic gastrostomy tube placement for end-stage palliation of malignant gastrointestinal obstructions. Saudi J Gastroenterol 2012; 18: 95-98
    CrossrefPubMedSuche in Google Scholar
  • 18 Dittrich A, Schubert B, Kramer M. et al. Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction. Support Care Cancer 2017; 25: 2849-2856
    PubMedSuche in Google Scholar
  • 19 Zucchi E, Fornasarig M, Martella L. et al. Decompressive percutaneous endoscopic gastrostomy in advanced cancer patients with small-bowel obstruction is feasible and effective: a large prospective study. Support Care Cancer 2016; 24: 2877-2882
    PubMedSuche in Google Scholar
  • 20 Marks WH, Perkal MF, Schwartz PE. Percutaneous endoscopic gastrostomy for gastric decompression in metastatic gynecologic malignancies. Surg Gynecol Obstet 1993; 177: 573-576
    PubMedSuche in Google Scholar
  • 21 Schlick CJR, Bentrem DJ. Timing of palliative care: When to call for a palliative care consult. J Surg Oncol 2019; 120: 30-34
    CrossrefPubMedSuche in Google Scholar
  • 22 Holm AN, Baron TH. Palliative use of percutaneous endoscopic gastrostomy and percutaneous endoscopic cecostomy tubes. Gastrointest Endosc Clin N Am 2007; 17: 795-803
    CrossrefPubMedSuche in Google Scholar
  • 23 Pothuri B, Montemarano M, Gerardi M. et al. Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma. Gynecol Oncol 2005; 96: 330-334
    CrossrefPubMedSuche in Google Scholar
  • 24 Tradounsky G. Palliation of gastrointestinal obstruction . Can Fam Physician 2012; 58: 648-652
    PubMedSuche in Google Scholar
  • 25 Canaz E, Sehouli J, Gebauer B. et al. CT fluoroscopy-guided percutaneous gastrostomy in the palliative management of advanced and relapsed ovarian cancer: the Charite experiences and a review of the literature. Cancers (Basel) 2023; 15
    CrossrefPubMedSuche in Google Scholar