title: 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.
authors.affiliation: Section of Interventional Radiology, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Colette
authors.initials: C
authors.lastname: Shaw
authors.forename: Roland L
authors.initials: RL
authors.lastname: Bassett
authors.forename: Patricia S
authors.initials: PS
authors.lastname: Fox
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Schmeler
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Overman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wallace
authors.forename: Sanjay
authors.initials: S
authors.lastname: Gupta
authors.forename: Alda
authors.initials: A
authors.lastname: Tam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000401:mortality*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D010166:Palliative Care; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult