Percutaneous endoscopic duodenostomy: the relief of obstruction in advanced gastric carcinoma

Abstract

Nausea and vomiting in patients with advanced gastric malignancy and mechanical obstruction are distressing and difficult to manage. We describe a patient with linitis plastica and gastric stasis who was treated with a percutaneous endoscopic duodenostomy as the stomach could not be used for percutaneous endoscopic gastrostomy (PEG) formation. A Conflo^TM PEG tube was inserted into the second part of the duodenum using the Ponsky–Gauderer technique without complication. The patient experienced excellent symptomatic relief and tolerated enteral nutrition extremely well, regaining some weight. This manoeuvre can produce effective symptom palliation allowing the patient to be managed at home during the terminal phase of their illness.

Keywords

duodenostomy endoscopy digestive system palliative care stomach neoplasms

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References

Ponsky JL , Gauderer MWL . Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. Gastrointest Endosc 1981; 27: 9–11.

Shike M . Percutaneous endoscopic stomas for enteral feeding and drainage. Oncol 1995; 9: 39–40.

Cannizzaro R , Bortolizzi F , Valenti M et al. PEG as a decompressive technique in bowel obstruction due to abdominal carcinomatosis. Endoscopy 1995; 27: 317–320.

Ponsky JL , Gauderer MW , Stellato TA . Percutaneous endoscopic gastrostomy: review of 150 cases. Arch Surg 1983; 148: 132–137.

Watson JP , Mannix KA , Matthewson K . Percutaneous endoscopic gastroenterostomy and jejunal extension for gastric stasis in pancreatic carcinoma. Palliat Med 1997; 12: 407–410.

Ponsky JL , Gauderer MWL . Percutaneous endoscopic gastroenterostomy versus surgical gastrostomy. J Parenter Enteral Nutr 1990; 14: 533–534.

Miller RE , Kummer BA , Tiszenkel HJ , Kotler DP . Percutaneous endoscopic gastrostomy: the procedure of choice. Ann Surg 1986; 204: 543–545.

Alberti-Flor JJ , Cochran JL , Vaughan S , Dunn GD . Percutaneous endoscopic duodenostomy. Gastrointest Endosc 1986; 32: 350–352.

Paul A , Vestweber KH , Bode C , Eyspach E . Percutaneous endoscopic duodenostomy. Surg Endosc 1987; 1: 123–126.

10.

Shike M , Latkany L et al. Direct percutaneous endoscopic jejunostomies for enteral feeding Gastrointest Endosc 1996; 44: 536–540.