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Original research
Endoscopically placed venting gastrostomy can be a safe and effective palliative intervention in benign and malignant gastrointestinal obstruction
  1. Ross J Porter1,2,
  2. Alastair W McKinlay1,
  3. Emma L Metcalfe1
  1. 1Department of Digestive Disorders, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
  2. 2Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Emma L Metcalfe, Department of Digestive Disorders, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK; emma.metcalfe{at}nhs.scot

Abstract

Introduction Chronic gastrointestinal obstruction can precipitate a constellation of symptoms including nausea, vomiting, abdominal distension and pain that negatively impact on health-related quality of life. Decompression via venting gastrostomy can offer symptomatic relief but safety and efficacy data are sparse. This study characterises the diverse venting percutaneous endoscopic gastrostomy (vPEG) cohort at our tertiary referral centre and defines the safety and efficacy of this procedure.

Methods Patients undergoing vPEG between May 2012 and June 2020 were identified from a prospectively maintained database and demographic, procedure-related and mortality data were extracted. Retrospective analysis of case notes provided data on patient symptoms. Last follow-up was May 2021.

Results 27 patients (median age 63, range 18–90 years) underwent vPEG insertion. The majority of vPEGs were for patients with obstruction secondary to locally advanced or metastatic malignancy (n=21/27, 77.8%). Six procedures were performed for benign disease (n=6/27, 22.2%). No patients developed the recognised serious complications of bleeding, perforation or peritonitis from vPEG insertion. Symptoms of nausea (p=0.006), vomiting (p<0.001), abdominal distension (p<0.001) and abdominal pain (p=0.002) were improved following vPEG. Pain beyond the expected postprocedural discomfort was associated with a lower number of days survived postprocedure (p=0.026).

Conclusion vPEG can be a safe and efficacious palliative intervention for benign and malignant chronic gastrointestinal obstruction. Severe postprocedural pain should be promptly investigated to exclude a potential complication. A defined clinical strategy for assessing and managing these patients would facilitate wider recognition of the benefits of vPEG and improve the safety profile in centres with more limited experience.

  • cancer
  • endoscopic gastrostomy
  • endoscopic procedures
  • gastrointestinal cancer

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Twitter @Porterrj0, @awmckinlay

  • Contributors ELM was the senior investigator for this study. RJP, ELM and AWM contributed to study design, data collection, data analysis, manuscript preparation and manuscript revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RJP reports grants from Edinburgh & Lothians Health Foundation which is unrelated to this submitted work. AWM is President (previously President Elect) of the British Society of Gastroenterology and Trustee of the Society and Director for BSG—this role is unpaid and has no direct relevance to the current paper. ELM has no conflicts of interest to declare.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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