Safety and efficacy of venting gastrostomy in malignant bowel obstruction: a systematic review
AffiliationDepartment of Interventional Radiology, Christie NHS Foundation Trust, Manchester
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AbstractMalignant bowel obstruction (MBO) is a common manifestation in patients with advanced intra-abdominal malignancy. It is especially common with bowel or gynecological cancers and produces distressing symptoms, including nausea, vomiting, and pain. Medical management options are less effective than decompressive strategies for symptom control. Surgery is the gold-standard treatment but is unsuitable for most patients with high complication rates. Consensus guidelines recommend nonsurgical management with a venting gastrostomy in those unsuitable for surgery or for whom medical management is ineffective. The aim of this systematic review is to establish the safety and efficacy of percutaneous venting gastrostomy in relieving symptoms of MBO. Twenty-five studies were included in this review comprising 1194 patients. Gastrostomy insertion was successful at first attempt in 91% of cases and reduction in symptoms of nausea and vomiting was reported in 92% of cases. Mean survival following the procedure ranged from 35 to 147 days. Major complications were rare, with most complications classed as minor wound infections or leakage of fluid around the tube. Studies suggest that the presence of ascites is not an absolute contraindication to the insertion of percutaneous venting gastrostomy in patients with MBO; however, these studies lack longitudinal outcomes and complication rates related to this. However, it is reasonable to suggest that ascitic drainage is performed to reduce potential complications. There is a relative lack of good quality robust data on the utilization of percutaneous venting gastrostomy in MBO, but overall, the combination of being a safe and efficacious procedure alongside the known complication profile suggests that it should be considered a suitable management option.
CitationThampy S, Najran P, Mullan D, Laasch HU. Safety and efficacy of venting gastrostomy in malignant bowel obstruction: a systematic review. J Palliat Care. 2019 Aug 25:825859719864915.
JournalJournal of Palliative Care
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- Percutaneous venting gastrostomy/gastrojejunostomy for malignant bowel obstruction: a qualitative study.
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- Palliative venting gastrostomy in patients with malignant bowel obstruction and ascites.
- Authors: Shaw C, Bassett RL, Fox PS, Schmeler KM, Overman MJ, Wallace MJ, Gupta S, Tam A
- Issue date: 2013 Feb
- Survival, Healthcare Utilization, and End-of-life Care Among Older Adults With Malignancy-associated Bowel Obstruction: Comparative Study of Surgery, Venting Gastrostomy, or Medical Management.
- Authors: Lilley EJ, Scott JW, Goldberg JE, Cauley CE, Temel JS, Epstein AS, Lipsitz SR, Smalls BL, Haider AH, Bader AM, Weissman JS, Cooper Z
- Issue date: 2018 Apr