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Percutaneous endoscopic gastrostomy with jejunal extension plus percutaneous endoscopic gastrostomy (PEG-j plus PEG) in patients with gastric/duodenal cancer outlet obstruction.
Arq Gastroenterol. 2015 Jan-Mar; 52(1):72-5.AG

Abstract

BACKGROUND

Stent palliation is the gold standard for gastric/duodenal cancer outlet obstruction. When stenting is impossible, feeding may be achieved through a gastrojejunostomy (PEG-J), but displacement of jejunal tube is frequent due to manipulation for feeding and drainage. Gastric outlet obstruction results on increased gastroesophageal reflux or extra-tube leakage. In order to reduce the jejunostomy tube manipulation and the gastric residuum, we created a second gastrostomy (PEG) dedicated to gastric drainage, reducing the PEG-J handling.

OBJECTIVE

Our aim was evaluating of the usefulness of an added second gastrostomy in a PEG-J patient, for: 1. controlling symptomatic reflux and extra-tube leakage; 2. preventing jejunal tube dislocation. Methods We retrospectively evaluated patients were stent palliation of gastric/duodenal cancer outlet obstruction was not achieved, who were referred and underwent PEG-J. We selected four of these patients who needed a second PEG dedicated to gastric drainage, which was performed a few centimetres apart from the gastrojejunostomy. In order to achieve an efficient gastric drainage and provide the maximum comfort to the patient, the drainage PEG tube could be linked to an ileostomy bag.

RESULTS

The four PEG-J cancer patients with longer survival developed symptoms associated with an important gastric residuum. After the drainage gastrostomy, symptoms subsided or vanished and there were no jejunal tube dislocations.

CONCLUSIONS

When stenting is not possible in patients with gastric/duodenal outlet obstruction due to cancer growing, feeding PEG-J plus drainage PEG may be an alternative, allowing duodenal/jejunal feeding and gastric drainage with minimal manipulation of the jejunal tube.

Authors+Show Affiliations

Hospital Garcia de Orta, Serviço de Gastrenterologia, GENE - Grupo de Estudo de Nutrição Entérica, Pragal, Almada, Portugal.Hospital Garcia de Orta, Serviço de Gastrenterologia, GENE - Grupo de Estudo de Nutrição Entérica, Pragal, Almada, Portugal.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26017087

Citation

Fonseca, Jorge, and Carla Adriana Santos. "Percutaneous Endoscopic Gastrostomy With Jejunal Extension Plus Percutaneous Endoscopic Gastrostomy (PEG-j Plus PEG) in Patients With Gastric/duodenal Cancer Outlet Obstruction." Arquivos De Gastroenterologia, vol. 52, no. 1, 2015, pp. 72-5.
Fonseca J, Santos CA. Percutaneous endoscopic gastrostomy with jejunal extension plus percutaneous endoscopic gastrostomy (PEG-j plus PEG) in patients with gastric/duodenal cancer outlet obstruction. Arq Gastroenterol. 2015;52(1):72-5.
Fonseca, J., & Santos, C. A. (2015). Percutaneous endoscopic gastrostomy with jejunal extension plus percutaneous endoscopic gastrostomy (PEG-j plus PEG) in patients with gastric/duodenal cancer outlet obstruction. Arquivos De Gastroenterologia, 52(1), 72-5. https://doi.org/10.1590/S0004-28032015000100015
Fonseca J, Santos CA. Percutaneous Endoscopic Gastrostomy With Jejunal Extension Plus Percutaneous Endoscopic Gastrostomy (PEG-j Plus PEG) in Patients With Gastric/duodenal Cancer Outlet Obstruction. Arq Gastroenterol. 2015 Jan-Mar;52(1):72-5. PubMed PMID: 26017087.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous endoscopic gastrostomy with jejunal extension plus percutaneous endoscopic gastrostomy (PEG-j plus PEG) in patients with gastric/duodenal cancer outlet obstruction. AU - Fonseca,Jorge, AU - Santos,Carla Adriana, PY - 2014/06/22/received PY - 2014/09/11/accepted PY - 2015/5/29/entrez PY - 2015/5/29/pubmed PY - 2015/10/7/medline SP - 72 EP - 5 JF - Arquivos de gastroenterologia JO - Arq Gastroenterol VL - 52 IS - 1 N2 - BACKGROUND: Stent palliation is the gold standard for gastric/duodenal cancer outlet obstruction. When stenting is impossible, feeding may be achieved through a gastrojejunostomy (PEG-J), but displacement of jejunal tube is frequent due to manipulation for feeding and drainage. Gastric outlet obstruction results on increased gastroesophageal reflux or extra-tube leakage. In order to reduce the jejunostomy tube manipulation and the gastric residuum, we created a second gastrostomy (PEG) dedicated to gastric drainage, reducing the PEG-J handling. OBJECTIVE: Our aim was evaluating of the usefulness of an added second gastrostomy in a PEG-J patient, for: 1. controlling symptomatic reflux and extra-tube leakage; 2. preventing jejunal tube dislocation. Methods We retrospectively evaluated patients were stent palliation of gastric/duodenal cancer outlet obstruction was not achieved, who were referred and underwent PEG-J. We selected four of these patients who needed a second PEG dedicated to gastric drainage, which was performed a few centimetres apart from the gastrojejunostomy. In order to achieve an efficient gastric drainage and provide the maximum comfort to the patient, the drainage PEG tube could be linked to an ileostomy bag. RESULTS: The four PEG-J cancer patients with longer survival developed symptoms associated with an important gastric residuum. After the drainage gastrostomy, symptoms subsided or vanished and there were no jejunal tube dislocations. CONCLUSIONS: When stenting is not possible in patients with gastric/duodenal outlet obstruction due to cancer growing, feeding PEG-J plus drainage PEG may be an alternative, allowing duodenal/jejunal feeding and gastric drainage with minimal manipulation of the jejunal tube. SN - 1678-4219 UR - https://www.unboundmedicine.com/medline/citation/26017087/Percutaneous_endoscopic_gastrostomy_with_jejunal_extension_plus_percutaneous_endoscopic_gastrostomy__PEG_j_plus_PEG__in_patients_with_gastric/duodenal_cancer_outlet_obstruction_ L2 - http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-28032015000100015&lng=en&nrm=iso&tlng=en DB - PRIME DP - Unbound Medicine ER -