Percutaneous endoscopic gastroenterostomy and jejunal extension for gastric stasis in pancreatic carcinoma

Abstract

Gastric stasis in pancreatic cancer without mechanical obstruction is distressing and difficult to manage. We describe two patients who were treated by percutaneous endoscopic gastroenterostomy (PEG) combined with a jejunal extension. Both patients had pancreatic cancer and gastric stasis, with recurrent vomiting and no evidence of distal duodenal obstruction. They were unresponsive to high-dose prokinetic agents. In both cases a Bower-PEG feeding tube with jejunal extension was inserted endoscopically, with clinical improvement. The technique has the advantages of permitting enteral feeding and allowing aspiration of upper gastrointestinal secretions between feeds, which produces symptomatic relief from nausea and vomiting. This manoeuvre can produce effective palliation, perhaps allowing the patient to be managed at home during the terminal phase of their illness.

Keywords

endoscopy gastrointestinal enteral feeding gastroparesis gastrostomy pancreatic neoplasms

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References

Bruera E. , Catz Z. , Hooper R. et al. Chronic nausea and anorexia in advanced cancer patients: a possible role for autonomic dysfunction. J Pain Symptom Manage 1987; 2: 19-21.

Thomas JP , Shields R. Associated autonomic dysfunction and carcinoma of the pancreas. Br Med J 1970; 4: 32.

Ponsky JL , Gauderer Mwl. Percutaneous endoscopic gastroenterostomy versus surgical gastrostomy . J Parenteral Enteral Nutrition 1990; 14: 533-34.

Cannizzaro R. , Bortolizzi F. , Valentini M. et al. PEG as a decompressive technique in bowel obstruction due to abdominal carcinomatosis. Endoscopy 1995; 27: 317-20.

Campagnutta E. , Cannizzaro R. et al. Palliative treatment of upper intestinal obstruction by gynaecologiocal malignancy: the usefulness of percutaneous endoscopic gastrostomy. Gynecol Oncol 1996 ; 62: 103-105.

Shike M. Percutaneous endoscopic stomas for enteral feeding and drainage. Oncol 1995; 9: 39-44.

Kadakia SC , Sullivan HO , Starnes E. Percutaneous endoscopic gastrostomy or jejunostomy and the incidence of aspiration in 79 patients. Am J Surg 1992 ; 164: 114-18.

Schuffer M. , Wallace H. , Flemming C. Intestinal pseudo-obstruction as the presenting manifestation of small-cell carcinoma of the lung: paraneoplastic neuropathy of the gastrointestinal tract . Ann Intern Med 1983; 98: 129-34.

McCarthy DO , Daun JM The role of prostaglandins in interleukin-1 induced gastroparesis. Physiol Behav 1992; 52: 351-53.

10.

Daun JM , McCarthy DO. The role of cholecystokinin in interleukin-1 induced anorexia . Physiol Behav 1993; 54: 237-41.

11.

Bruera E. , Chadwick S. , Fox R. et al. Study of cardiovascular autonomic insufficiency in advanced cancer patients Cancer Treat Rep 1986; 70: 1383-87.