Tunneled Percutaneous Transesophageal Gastrostomy for Treatment of Malignant Bowel Obstruction

Abstract

ABSTRACT Introduction Malignant bowel obstruction is a common complication in patients with end-stage cancer. Gastric decompression can reduce symptoms; however, percutaneous gastrostomy tube placement may not always be feasible. A percutaneous transesophageal gastrostomy (PTEG) is an alternative for nasogastric decompression. This study describes a technical modification of PTEG tube placement for patient comfort. Methods: A single-center retrospective review was performed to compare outcomes from tunneled versus nontunneled PTEGs. Similar to previous descriptions, an esophageal balloon was percutaneously punctured with a needle for placement of a tube entering the neck and tracked through the esophagus into the stomach. Rather than suturing to the neck, the tube was navigated through a subcutaneous tunnel to create a tunneled transesophageal gastrostomy. Results: Between Dec 2017 and Oct 2023, 27 patients underwent attempted PTEG tube placement, 10 of which were tunneled. Median time to death was 24 days after the procedure. Adverse events occurred in 10 of 27 patients (37.0%) and included cellulitis, tube retraction requiring tube repositioning and replacement, tube clogging, failed placement, postprocedure extended intubation, postprocedure hypotension, and aspiration. More infections were noted in the tunneled PTEGs than in the nontunneled PTEGs. Twenty-four patients reported partial or complete symptom relief. Seventeen patients were able to tolerate a liquid, low-fiber, or soft regular diet with a PTEG. Conclusion: Using established techniques of tunneling central venous catheters and the process of placing PTEG tubes, a simple modification to the procedure can have the gastrostomy exit along the chest wall rather than the neck. However, this may cause increased infectious complications.