Percutaneous Transesophageal Gastrostomy (PTEG): A Safe and Well-Tolerated Procedure for Palliation of End-Stage Malignant Bowel Obstruction

• Published in: Journal of pain and symptom management 2019-08, Vol.58 (2), p.306-310
• Main Authors: Selby, Debbie, Nolen, Amy, Sittambalam, Cheromi, Johansen, Karen, Pugash, Robyn
• Format: Article
• Language: English
• Subjects: Cancer; Colorectal cancer; Disease management; End of life decisions; gastrointestinal decompression; Hospice care; Intestinal obstruction; Malignant; Malignant bowel obstruction; Medical diagnosis; Morbidity; Obstruction; Ostomy; Palliative care; Patients; percutaneous transesophageal gastrostomy; Quality of life; Symptom management; Symptoms; Terminal illnesses
• ISSN: 0885-3924; 1873-6513
• DOI: 10.1016/j.jpainsymman.2019.04.031

Malignant bowel obstruction (MBO) is a frequent complication in patients with advanced cancer. Symptom management for patients with end-stage MBO can be challenging, especially when venting gastrostomy is contraindicated. Percutaneous transesophageal gastrostomy (PTEG) is an alternative option allowing safe and effective symptom management in palliative care patients. We describe our experience with an initial series of 10 patients with MBOs refractory to medical management who received PTEG for gastrointestinal decompression, with a focus on palliative outcomes and safety. We retrospectively reviewed the charts of 10 patients with advanced malignancy and associated gastrointestinal obstruction who received PTEG for symptom management between March 2018 and November 2018. We report on patient diagnosis, indications for PTEG, outcomes after insertion, and any associated morbidity and mortality. PTEGs were successfully inserted in all 10 patients with contraindications to a venting gastrostomy. There were no acute postprocedural complications. Median time from PTEG insertion to death was 15 days. Symptoms of MBO improved in all 10 patients, and all were able to resume some degree of oral intake. Importantly, unlike with venting gastrostomies, all patients required suction to maintain resolution of MBO symptoms. PTEG should be considered for gastrointestinal decompression in patients with MBO who are not candidates for surgical decompression or standard venting gastrostomy. This safe and effective procedure improves symptom management and quality of life for patients with MBO who are approaching end of life.