Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Gastrointestinal Cancers: Prognosis and Implications for Timing of Palliative Intervention

Pinard, Kerry-Ann; Goring, Tabitha N.; Egan, Barbara; Koo, Douglas J.

doi:10.1089/jpm.2016.0465

Cited by 16 publications

(12 citation statements)

References 9 publications

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“…Alternatives to surgery such as venting gastrostomy tubes and stents, while having fewer complications, are typically used in patients who have poor performance status and likely would not tolerate surgery. 19,20 In our study, those treated with gastrostomy tubes uniformly had the worst outcomes in terms of length of stay, mortality, and survival compared to those treated with stents, surgery, and medical management. Similarly, Lilley et al 5 reported that patients with IO from pancreatic and ovarian cancer treated with venting gastrostomy tubes had shorter survival (median: 38 vs 128 days) and higher 30day mortality (43% vs 18%) compared to those undergoing surgery.…”

Section: Discussionmentioning

confidence: 63%

Management of Cancer-Associated Intestinal Obstruction in the Final Year of Life

et al. 2019

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Background: There is variation in the clinical management of intestinal obstruction (IO) in patients with cancer. We describe the management of cancer-associated IO near the end of life in a population-based cohort with universal health coverage. Methods: Patients who died of gastric, colorectal, ovarian, and pancreatic cancers from 2002 to 2015 were identified from the Ontario Cancer Registry. Those with ≥1 hospital admission for IO in the final year of life were identified from administrative data. Management of IO at index admission was categorized as surgery, gastrostomy, stent, feeding jejunostomy, and medical management. Trends in management over the study period were assessed by the Cochran-Armitage test. Results: The cohort included 57 378 patients (gastric [n = 7448, 13%], colorectal [n = 30 577 53%], ovarian [n = 6273, 11%], and pancreatic [n = 13 080, 23%] cancers). Of those, 7618 (13%) patients had ≥1 admission for IO in the final year of life. Of these patients, 2657 (35%) patients were managed with a surgical/procedural intervention at index admission (surgery [86%], gastrostomy [8%], stent [6%], and jejunostomy [0.4%]); the remaining patients (n = 4961, 65%) received medical management. Over the study period, there was a small but statistically significant increase in the use of stents (0% in 2002 to 5% in 2015, P < .0001) and gastrostomy tubes (2% in 2002 to 4% in 2015, P = .002) and a large decrease in the use of surgery (41% in 2002 to 28% in 2015, P = .04). Conclusions: Management of IO has changed over time with the increased use of stents and gastrostomy tubes and decreased use of surgery.

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Section: Discussionmentioning

confidence: 63%

Management of Cancer-Associated Intestinal Obstruction in the Final Year of Life

et al. 2019

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“…Therefore, PEG insertion is preferable for patients who are required to maintain enteral feeding for a long period, because the quality of life should be considered 14 . As the indications for PEG insertion expand, patients who require continuous drainage for malignant bowel obstruction also undergo PEG to drain gastric fluid and resolve nausea or vomiting 15,16 . There is an increasing number of patients undergoing PEG insertion for such reasons, and many research studies relating to the procedure have been performed.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Enteral Feeding Protocol Via Percutaneous Endoscopic Gastrostomy: A Single‐Center, Retrospective Study

Noh

Ahn

et al. 2020

Nut in Clin Prac

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Background The development of the endoscopic technique has resulted in an increasing number of patients undergoing percutaneous endoscopic gastrostomy (PEG) insertion; however, the protocols for increasing the volume of feeding formula after PEG insertion have not been established. Therefore, we compared the clinical outcomes of patients receiving low‐ and high‐volume increase in enteral feeding formula. Methods A total of 215 patients who underwent PEG insertion between January 2016 and March 2019 were included. They were divided into 2 groups according to the increase in volume of feeding formula: the low‐volume group (n = 135) received ≤150 mL/d, and the high‐volume group (n = 80) received ≥300 mL/d. Patient characteristics, procedure, and feeding‐related clinical outcomes were retrospectively reviewed using medical records. Results The adverse events of the feeding protocol did not significantly differ between the 2 groups. The number of days needed to attain the calorie targets was significantly lower in the high‐volume group than in the low‐volume group (5.4 ± 3.0 vs 2.4 ± 1.5; P < .001). The duration of supplemental parenteral nutrition and the length of hospitalization were also significantly lower in the high‐volume group (3.9 ± 3.3 vs 1.2 ± 2.2; P < .001 and 5.8 ± 2.7 vs 4.6 ± 2.6; P = .007, respectively). Conclusion To rapidly attain the calorie targets in appropriately selected patients with PEG insertion, a high‐volume increase in daily feeding can safely be recommended given the favorable outcomes.

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“…PEG tube placement for gastric decompression has also been described as a feasible palliative option for patients with malignant bowel obstruction, but is often associated with higher risk of complications and poor prognosis (38,59,60).…”

Section: Gastric Decompressionmentioning

confidence: 99%

An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Wei¹,

Ho²,

Hegde³

2021

J Thorac Dis

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Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.

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Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Gastrointestinal Cancers: Prognosis and Implications for Timing of Palliative Intervention

Cited by 16 publications

References 9 publications

Management of Cancer-Associated Intestinal Obstruction in the Final Year of Life

Management of Cancer-Associated Intestinal Obstruction in the Final Year of Life

Clinical Outcomes of Enteral Feeding Protocol Via Percutaneous Endoscopic Gastrostomy: A Single‐Center, Retrospective Study

An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit

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