title: Decompressive percutaneous endoscopic gastrostomy in advanced cancer patients with small-bowel obstruction is feasible and effective: a large prospective study.
abstract: The purpose of this study was to evaluate patient-centered outcomes of decompressive percutaneous endoscopic gastrostomy (dPEG) in patients with malignant bowel obstruction due to advanced gynecological and gastroenteric malignancies.
  
  
  
  This is a prospective analysis of 158 consecutive patients with small-bowel obstruction from advanced gynecological and gastroenteric cancer who underwent PEG or percutaneous endoscopic jejunostomy (PEJ) positioning for decompressive purposes from 2002 to 2012. All of them had previous abdominal surgery and were unfit for any other surgical procedures. Symptom relief, procedural complications, and post dPEG palliation were assessed. Global Quality of Life (QoL) was evaluated in the last 2 years (25 consecutive patients) before and 7 days after dPEG placement using the Symptom Distress Scale (SDS).
  
  
  
  dPEG was successfully performed in 142 out of 158 patients (89.8 %). Failure of tube placement occurred in 16 patients (10.1 %). In 8/142 (5.6 %) patients, dPEG was guided by abdominal ultrasound. In 3/142 patients, dPEG was CT-guided. In 14 (9.8 %) patients, who had previously undergone total or subtotal gastrectomy, decompressive percutaneous endoscopic jejunostomy (dPEJ) was performed. In 1/14 patients, dPEJ was CT-guided. Out of 142 patients, 110 (77.4 %) experienced relief from nausea and vomiting 2 days after PEG. Out of 142 patients, 116 (81.6 %) were discharged. The median postoperative hospital stay was 9 days (range 3-60). Peristomal infection (14 %) and intermittent obstruction (8.4 %) were the most frequent complications associated with PEG. Median survival time was 57 days (range 4-472) after PEG placement. Twenty-five patients had QoL properly evaluated with SDS score before and 7 days after dPEG. Sixteen patients (64 %) out of 25 exhibited an improvement of QoL (p < 0.05), 7 (28 %) patients exhibited a non-significant worsening of QoL (p = 0.18), and in 2 (8 %) patients, it remained unmodified.
  
  
  
  dPEG is feasible, effective, relieves nausea and vomiting in patients with unremitting small-bowel obstruction from advanced gynecological and gastroenteric cancer, and improves QoL.
authors.affiliation: Department of Gastroenterology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Via Franco Gallini, 2 33081, Aviano, PN, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Zucchi
authors.affiliation: Department of Gastroenterology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Via Franco Gallini, 2 33081, Aviano, PN, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Fornasarig
authors.affiliation: Department of Surgery, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Aviano, PN, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Martella
authors.affiliation: Department of Gastroenterology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Via Franco Gallini, 2 33081, Aviano, PN, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Maiero
authors.affiliation: Division of Gynecologic Oncology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Aviano, PN, Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Lucia
authors.affiliation: Department of Nuclear Medicine, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Aviano, PN, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Borsatti
authors.affiliation: Department of Radiology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Aviano, PN, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Balestreri
authors.affiliation: Division of Gynecologic Oncology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Aviano, PN, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Giorda
authors.affiliation: Unit of Oncological Psychology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Aviano, PN, Italy.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Annunziata
authors.affiliation: Department of Gastroenterology, National Cancer Institute, Centro di Riferimento Oncologico IRCCS, Via Franco Gallini, 2 33081, Aviano, PN, Italy. rcannizzaro@cro.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Cannizzaro
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000150:complications* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life
keywords: Cancer; Gastrointestinal occlusion; Gastrostomy; Jejunostomy; Palliative treatment; Peritoneal carcinomatosis
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