Safety and efficacy of venting percutaneous radiologic gastrostomies in malignant bowel obstruction: a comprehensive cancer centre experience

Malignant 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.

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Safety and efficacy of percutaneous venting gastrostomy tubes for malignant bowel obstruction and ascites

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2016.12.833 ◽

2017 ◽

Vol 28 (2) ◽

pp. S99

Author(s):

S Harmoush ◽

M Briones Dimayuga ◽

A Tam ◽

B Odisio ◽

R Sheth ◽

...

Keyword(s):

Bowel Obstruction ◽

Malignant Bowel Obstruction ◽

Safety And Efficacy ◽

Gastrostomy Tubes

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Safety and efficacy of percutaneous transabdominal and transesophageal decompression gastric catheters for palliation of malignant bowel obstruction

Abdominal Radiology ◽

10.1007/s00261-021-03115-7 ◽

2021 ◽

Author(s):

Robert J. Litwin ◽

Alda L. Tam ◽

Rahul A. Sheth ◽

Steven M. Yevich ◽

Johanna L. Chan ◽

...

Keyword(s):

Bowel Obstruction ◽

Malignant Bowel Obstruction ◽

Safety And Efficacy

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196 A clinical audit of use of octreotide in the management of inoperable malignant bowel obstruction at a large cancer centre

10.1136/spcare-2020-pcc.216 ◽

2020 ◽

Author(s):

Jennifer Palfrey ◽

Vandana Vora

Keyword(s):

Bowel Obstruction ◽

Clinical Audit ◽

Malignant Bowel Obstruction ◽

Cancer Centre

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Implementation of malignant bowel obstruction multidisciplinary case conferences (MCCs) to improve clinical decision making in malignant bowel obstruction (MBO) in gynecologic oncology.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e18322 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e18322-e18322

Author(s):

Gita Bhat ◽

Ainhoa Madariaga ◽

Luisa Bonilla ◽

Yeh Chen Lee ◽

Neesha C. Dhani ◽

...

Keyword(s):

Decision Making ◽

Interventional Radiology ◽

Bowel Obstruction ◽

Clinical Management ◽

Clinical Decision Making ◽

Gynecologic Oncology ◽

Clinical Decision ◽

Management Plan ◽

Malignant Bowel Obstruction ◽

Cancer Centre

e18322 Background: Though patients (pts) with gynecological cancer are at higher risk of MBO, clinical management is not well defined. We implemented a coordinated team approach to evaluate MBO at Princess Margaret Cancer Centre. The Princess Margaret Cancer Centre inter-professional MBO management program includes nurse led ambulatory symptom management, inpatient treatment algorithm, patient directed bowel management education & MCCs. This study evaluates the utility of MBO MCC on clinical decision making in gynecologic oncology. Methods: Monthly MBO MCCs are conducted to discuss complex clinical management issues. A clinical summary is presented prior to the discussion with each case incorporating radiology review followed by interdisciplinary discussion. In this study, the initial management plan was compared to post-MCC consensus. A change in plan was defined as a consensus plan different from the pre-MCC plan or no definite plan prior to MCC. Barriers to implementation of the consensus were analyzed. Results: From December 2016 to November 2018, 90 pts were discussed in 22 MCCs. Of these, 60 had high grade serous ovarian carcinoma (67%) & 64 had small bowel obstruction (71%). Discussion in MCCs lead to a change in management plan in 49 cases(54%). These changes included recommendations for palliative surgery (25%) or radiation (10%), interventional radiology (23%), pharmacologic management alone (14%), imaging studies (4%) & total parenteral nutrition (TPN) (4%). Chemotherapy continuation, break or regimen changes were recommended in 20%. MCC consensus plan could not be implemented in 11 cases (23%). The barriers were refusal of surgery (8%), interventional radiology procedures (2%), TPN (4%) by patients, functional decline (6%) & inability to create a colostomy due to dense adhesions (2%). During MCC referrals to the dietitian & palliative care team were planned for 16 (18%) & 22 (24%) pts respectively. Conclusions: Interdisciplinary MBO MCCs have a significant impact on decision making in complex MBO cases. Radiology review & group discussion facilitates greater clarity in formulation of a management plan.

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