LAUSR

Introduction Chronic nausea, vomiting and pain are all well recognised to negatively impact on health-related quality of life. In patients with gastrointestinal obstruction, gastric decompression via venting gastrostomy can offer symptomatic relief. However, the benefits must be considered against the risks associated with the invasive procedure, especially in malignant disease with a limited prognosis. Data on this important and largely uncharacterised cohort are sparse. We describe this population and outcome data from our specialist centre over a six-year period. Methods Patients undergoing vPEG insertion between 2012–2018 were prospectively identified from a designated PEG database. Data were extracted from medical records with last follow-up November 2018. Analysis was descriptive. Caldicott Guardian approval was granted. Results Nineteen patients (male n=11, female n=8) were identified; mean age 59.9 years (range 18–90). Fourteen had malignant obstruction secondary to locally advanced or metastatic cancer from upper gastrointestinal (n=8, 57%), colorectal (n=5, 36%), or gynaecological (n=1, 7%) sites. Five had benign obstruction from post-operative complications (n=3, 60%), gastric outlet obstruction (n=1, 20%), or connective tissue sequelae (n=1, 20%). Tube insertion was successful in eighteen (95%) patients, discussed hereafter. There were no procedure related complications of bleeding, perforation or peritonitis (as defined on CT or requiring surgery). No patients had post-procedure pain significant enough to require CT imaging within the first seven days. However, one patient (5.6%) with malignancy sustained a confirmed perforation during secondary placement of a jejunal extension tube for feeding. In three benign cases (60%) versus zero malignant cases, the gastrostomy had been removed during the follow-up period. Benign indications were associated with better survival outcomes compared to malignant disease (mean 795 days/ range 107–1917+ and 60.4 days/ range 2–258, respectively). From data available (n=10), all patients reported resolution or improvement of nausea, vomiting or pain. Conclusions Our data supports the use of vPEG as a safe and effective palliative intervention in both benign and malignant gastrointestinal obstruction. A defined strategy for the assessment of such patients is lacking and development of an agreed clinical pathway may streamline and improve patient care. Important such considerations would include up-to-date imaging to delineate anatomy, and prior gastric decompression with a wide bore nasogastric tube to reduce the risks of aspiration and peritonitis.