Percutaneous Gastrostomy as a Venting Procedure in Palliative Care

The role of venting percutaneous gastrostomy (PG) is decribed in the management of five patients with nausea and vomiting or visceral pain due to terminal advanced obstructive intra-abdominal carcinomatosis. Percutaneous endoscopic gastrostomy (PEG) was used in three cases, the other two were inserted under radiological control and at laparotomy respectively. Impressive symptom relief was obtained in all cases with minimal morbidity. Two of the patients survived for prolonged periods of time (two and five months respectively) at home, and fluid and electrolyte imbalance did not appear to be a clinical problem in either case. The other three patients had brief but comfortable terminal illnesses in the hospice. The wider study of this procedure is advocated for obstructive or motility complications of advanced intra-abdominal malignancy, and also for nonmechanical causes of intractable nausea and vomiting in terminal illness where pharmacological measures fail. For this small but distressed subgroup of patients, PG may be a more effective and acceptable alternative to the prolonged use of nasogastric tubes. Further evaluation of effectiveness, impact on biochemistry, hydration and quality of life is required, particularly for longer-term use.