A G-Tube Placed in the Side of Neck: Percutaneous Transesophageal Gastrostomy (PTEG) for Palliation of Malignant Bowel Obstruction (Sci201)

Document Type

Conference Proceeding

Publication Date

5-1-2023

Publication Title

Journal Of Pain And Symptom Management

Abstract

Outcomes: 1. Participants will self-report the ability to utilize percutaneous transesophageal gastrostomy (PTEG) as a palliative treatment option for certain patients with malignant obstruction. 2. Participants will self-report the ability to recognize that PTEG can be as safe and effective as a traditional percutaneous gastrostomy tube. Malignant bowel obstructions may occur in certain advanced cancers, typically presenting with severe pain, intractable nausea, vomiting, or reflux that greatly impairs quality of life. Treatment options include surgical and nonsurgical interventions, such as opioid analgesics, steroids, and anti-secretory and anti-emetic medications, in combination, when feasible, with surgical bypass, luminal stenting, and/or a venting gastrostomy. Those with malignant bowel obstructions with peritoneal disease or malignant ascites are often precluded from interventions. We present an alternative intervention called percutaneous transesophageal gastrostomy (PTEG) that may be offered to patients when a traditional percutaneous gastrostomy cannot be used. We describe a 57-year-old male with stage IV esophageal cancer complicated by peritoneal carcinomatosis and malignant ascites who presented with intractable nausea, vomiting, and reflux, diagnosed with malignant bowel obstruction. Multimodal medical therapies were trialed without relief, and he ultimately was left nasogastric tube (NGT) dependent. This form of gastric venting did adequately control his symptoms. He was not a candidate for other interventions, including a traditional palliative venting gastrostomy due to his peritoneal disease. With evidence that NGT with venting was the only helpful treatment, he underwent a successful PTEG placement by interventional radiology. He found near complete resolution in his obstructive symptoms as well as his throat and nose pain associated with the NGT were also eliminated. The application of the PTEG as a palliative intervention for malignant bowel obstruction is not widely recognized. This form of gastrostomy is effective for venting, feeding, or a combination of both, and is as safe when compared to a traditional gastrostomy. PTEG has been shown to improve quality of life and improve symptom burden when compared to NGT. We present this case to promote wider recognition of PTEG use for those patients who are ineligible for traditional interventions.

Volume

65

Issue

5

First Page

e640

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