title: Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction.
abstract: OBJECTIVE
  Obstructive symptoms are common in advanced malignancies. Venting percutaneous endoscopic gastrostomy (VPEG) tubes can be placed for palliation. The aim of this study was to determine the outcomes of VPEG placement in patients with advanced malignancy.
  
  
  METHODS
  We retrospectively reviewed patients in whom a VPEG tube was attempted for a malignant indication from 1998 to 2010 at a tertiary care center. Clinical information, procedure details, and adverse events (AEs) were recorded.
  
  
  RESULTS
  Ninety-six patients meeting the inclusion criteria were identified. Colorectal (27 %), pancreas (18.8 %), and gynecologic (17.7 %) malignancies were most common. Overall, 46.9 % of patients had ascites, with 35.6 % undergoing drainage prior to VPEG placement. VPEG placement was successful in 89 patients (92.7 %), and relief of obstructive symptoms was observed in 91.0 % of patients. Seven patients had refractory symptoms despite functioning VPEG tube. Ten post-procedural AEs were noted in nine patients, with one death. Infectious complications were more common in patients with ascites (12.2 %) versus those without (0 %; p = 0.02). There was a trend towards decreased infectious AEs when ascites was drained prior to VPEG (14.8 vs. 7.1 %; p = 0.64) in our patient cohort. We observed a decreased survival when AEs occurred (73 ± 47.8 days) compared with when they did not occur (141 ± 367.8 days; p = 0.61).
  
  
  CONCLUSIONS
  VPEG tubes can be safely placed in patients with obstructive symptoms due to inoperable malignancy, with complete relief in the majority of patients. Ascites was a risk factor for post-procedural infectious AEs. Drainage of ascites prior to VPEG tube placement may decrease this risk, although this requires further study.
authors.affiliation: Division of Internal Medicine, Feinberg School of Medicine, Northwestern University, 251 E. Huron, Galter 3-150, Chicago, IL, 60611, USA, rachel-issaka@fsm.northwestern.edu.
authors.forename: Rachel B
authors.initials: RB
authors.lastname: Issaka
authors.forename: David M
authors.initials: DM
authors.lastname: Shapiro
authors.forename: Neehar D
authors.initials: ND
authors.lastname: Parikh
authors.forename: Mary F
authors.initials: MF
authors.lastname: Mulcahy
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
authors.forename: John A
authors.initials: JA
authors.lastname: Martin
authors.forename: Rajesh N
authors.initials: RN
authors.lastname: Keswani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult