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Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction

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Abstract

Purpose

Gastrointestinal obstruction presents many burdens for patients with end-stage abdominal cancer, such as nausea and vomiting. Few detailed data on the efficacy of a percutaneous endoscopic gastrostomy (PEG) for decompression exists. This retrospective cohort study investigates the quantity of symptom relief realized with PEG and the corresponding complications.

Methods

Chart reviews of 75 patients with malignant gastrointestinal obstruction, who received a PEG for decompression, were performed. Abstracted data includes symptoms (vomiting, nausea, abdominal pain) and medication up to 7 days before and after the intervention, complications, demographics, potential influencing factors and survival. Generalized estimating equations (GEE) models determined symptom reduction.

Results

PEG decreased the mean frequency of vomiting per day from 2.2 (95% confidence interval (CI) 1.7–2.7) to 0.4 (95% CI 0.3–0.6) (p < 0.001). The probability of the occurrence of nausea on a given day was 80% (95% CI 74–85%) prior to the PEG placement and 40% (95% CI 34–47%) afterwards (p < 0.001). One hundred twelve complications were reported in 56 patients (none 19/75 patients (25%), minor 52/75 (69%), major 18/75 (24%)). Stomal leakage (18/75 patients), mild wound pain (17/75) and tube occlusion (13/75) occurred most frequently. The failure of the first attempt of the PEG placement (7/75) presented as the leading major complication.

Conclusions

The PEG for decompression significantly reduces vomiting and nausea in patients with malignant gastrointestinal obstruction (p < 0.001). Minor complications are common and should be discussed prior to the intervention. Nevertheless, the PEG appears to demonstrate prevailing benefits in comparison to the risks.

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Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Anne Dittrich, Michael Kramer, Felicitas Lenz, Ulrich Schuler & Markus K. Schuler

  2. Department of Internal Medicine, St. Joseph-Stift Hospital Dresden, Wintergartenstraße 15/17, 01307, Dresden, Germany

    Barbara Schubert

  3. Department of Gynecology and Obstetrics, University Hospital Carl Gustav Carus, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany

    Karin Kast

  4. Department of Internal Medicine II, HELIOS Hospital Emil von Behring, Walterhöferstraße 11, 14165, Berlin, Germany

    Markus K. Schuler

Authors
  1. Anne Dittrich
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  2. Barbara Schubert
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  3. Michael Kramer
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  4. Felicitas Lenz
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  5. Karin Kast
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  6. Ulrich Schuler
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  7. Markus K. Schuler
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Corresponding author

Correspondence to Anne Dittrich.

Ethics declarations

The study was approved by the institutional review board at the Technical University Dresden (EK 102032014).

Conflict of interest

The authors declare that they have no conflict of interest.

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Dittrich, A., Schubert, B., Kramer, M. et al. Benefits and risks of a percutaneous endoscopic gastrostomy (PEG) for decompression in patients with malignant gastrointestinal obstruction. Support Care Cancer 25, 2849–2856 (2017). https://doi.org/10.1007/s00520-017-3700-1

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  • DOI: https://doi.org/10.1007/s00520-017-3700-1

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