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World J Gastrointest Endosc. Apr 16, 2015; 7(4): 364-369
Published online Apr 16, 2015. doi: 10.4253/wjge.v7.i4.364
Palliative percutaneous endoscopic gastrostomy placement for gastrointestinal cancer: Roles, goals, and complications
Matthew Mobily, Jitesh A Patel
Matthew Mobily, Departments of Surgery, University of Arizona, Tucson, AZ 85724, United States
Jitesh A Patel, Division of General Surgery, University of Kentucky, Lexington, KY 40536, United States
Author contributions: Mobily M and Patel JA equally contributed to this paper.
Conflict-of-interest: There are no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jitesh A Patel, MD, Division of General Surgery, University of Kentucky, 800 Rose Street, UKMC C221, Lexington, KY 40536, United States. jitesh.patel@uky.edu
Telephone: +1-859-3236346 Fax: +1-859-3236840
Received: September 1, 2014
Peer-review started: September 2, 2014
First decision: October 28, 2014
Revised: December 11, 2014
Accepted: January 9, 2015
Article in press: January 12, 2015
Published online: April 16, 2015
Abstract

Percutaneous endoscopic gastrostomy tube placement is an invaluable tool in clinical practice that has an important role in the palliative care of patients with gastrointestinal cancer. While there is no extensive data regarding the use of this procedure in patients with gastrointestinal malignancy, inferences can be made from the available information derived from studies of similar or mixed populations. Percutaneous endoscopic gastrostomy tubes can be used to provide enteral nutrition for terminal malignancies of the upper gastrointestinal tract as well as for decompression of malignant obstructions. The rates of successful placement for cancer patients with either of these indications are high, similar to those in mixed populations. There is no conclusive evidence that the procedure will help patients reach nutritional goals for those needing alimental supplementation. However, it is effective at relieving symptoms caused by malignant obstruction. A high American Society of Anesthesiologist physical status score and an advanced tumor stage have been shown to be independent predictors of poor outcomes following placement in cancer patients. This suggests the potential for similar outcomes in the palliative care of patients with advanced stage gastrointestinal cancer who may be in relatively poor physiologic condition. However, this potential should not preclude its use in patients with terminal gastrointestinal cancer considering the high rate of successful tube placement, the possible benefits and the ultimate goal of comfort in palliative care.

Keywords: Percutaneous endoscopic gastrostomy tube, Palliative care, gastrointestinal cancer, Nutritional supplementation, Gastrointestinal decompression

Core tip: Percutaneous endoscopic gastrostomy tube placement may be used in the palliative care of patients with gastrointestinal cancer for supplemental nutrition or to decompress distal obstructions. There is a high rate of successful placement in cancer patients. It has been shown to relieve symptoms of malignant obstruction and has the potential to help patients reach nutritional goals. While poor physiologic condition and advanced tumor stage have been associated with a higher risk of worse outcomes, this should not preclude its use in these patients considering the high rate of successful placement, potential benefits and the goal of comfort in palliative care.