Gastrostomy Tube for Nutrition and Malignant Bowel Obstruction in Patients With Cancer

Abstract

Background: Gastrostomy tubes (G-tubes) are invaluable clinical tools that play a role in palliation and nutrition in patients with cancer. This study aimed to better understand the risks and benefits associated with the placement and maintenance of G-tubes. Methods: Patients who underwent placement of a G-tube for cancer from January 2013 through December 2017 at a tertiary care center were considered for inclusion. Clinical data were retrospectively collected from medical records. Results: A total of 242 patients with cancer, whose average age at diagnosis was 61 years (range, 21–94 years), underwent G-tube placement for nutrition (76.4%), decompression (22.7%), or both (0.8%). Successful insertion was achieved in 96.8%, but 8 patients required >1 attempted method of insertion. In the decompression group, minor postplacement complications were less common (23.6% vs 53.5%; P<.001) and survival was shorter (P<.001) compared with the nutrition group. For those with decompressive G-tubes, 45.5% had a palliative care consult; 56.4% were seen by social workers; and 46.3% went to hospice. The frequency of hospice discharge was higher in patients who had consults (53.7% vs 23.1%; P=.01). Conclusions: Half of the patients who received decompressive G-tubes presented with stage IV disease and died within 1 month of placement. Those with >1 consult were more likely to be discharged to hospice. Patients with G-tubes for nutrition saw no change in functionality, complication rate, or survival, regardless of adjunct chemotherapy status. These findings illustrate the need for a tool to allow a better multidisciplinary approach and interventional decision-making for patients with cancer.

Venting percutaneous radiologic gastrostomy in malignant bowel obstruction: safety and effectiveness in a comprehensive cancer centre

“…More than 50% of the patients were able to be discharged, and one-third of these returned home. These data are consistent with previous studies 9 11 12 15…”

“…There were no deaths due to VPRG complications. A recent systematic review reports a success rate of venting gastrostomy placement at first attempt in 1081 of 1194 cases (91%),13 and similar results have been shown by Gaubin in VPRG placement 15. In our series, VPRG was successfully performed at first attempt in all patients.…”

Inoperable malignant bowel obstruction: palliative interventions outcomes – mixed-methods systematic review

“…Online supplemental file 4 provides summary descriptions of the included quantitative studies. There were 6 prospective,27–32 35 retrospective cohort studies,7 8 33–67 1 mixed-method study68 and 2 RCTs 69 70. Sample sizes ranged from 7 to 629.…”

“…Sample sizes ranged from 7 to 629. Studies were globally represented; 1 study from Australasia,50 5 from Asia,31 40 60 69 70 17 from Europe27–30 32 35 39 42 44–47 54 64 67 68 and 21 from North America 7 8 33 34 36–38 43 49 52 53 55–59 61–63 65 66…”

“…64 66 One study reported percentage alive at 30 days, 1 year and 3 years, of 54.8%, 11.43% and 9.5%, respectively. 55 One study stated survival of 50 days for the PVG group and 86 days for the nasogastric tube group without further qualification of the measure. 69…”