From the Guidelines
Percutaneous endoscopic gastrostomy (PEG) tube placement is indicated in patients with metastatic cancer and intestinal obstruction for palliative drainage of gastric juices and secretions, as well as for enteral nutrition.
Indications for PEG Tube Placement
- Palliative drainage of gastric juices and secretions in the presence of a chronic gastrointestinal stenosis or ileus 1
- Enteral nutrition in patients with malignant obstruction who cannot tolerate an oral diet 1
- Patients with esophageal or gastric cardia obstruction who require enteral feeds 1
Considerations for PEG Tube Placement
- Timing of PEG placement: should be individualized and considered early in patients who are expected to require enteral access for 4 or more weeks 1
- Type of enteral feed: should be discussed with the surgeon before proceeding, as PEG placement can make subsequent gastric conduit formation in patients undergoing esophagectomy difficult 1
- Potential complications: include tube blockage, dislodgement, infection, and abdominal wall seeding 1
Alternative Options
- Nasogastric/nasojejunal tubes: may be used for short-term enteral access, but are associated with a higher risk of dislodgement and tube-related complications 1
- Percutaneous gastrostomy with jejunal extension: may be used in patients with altered intestinal anatomy or those who require small bowel feeding 1
- Endoscopic placement of self-expandable metal stents: may be used to alleviate or bypass obstruction in patients with malignant gastric outlet obstruction 1
From the Research
Indications for PEG Tube Placement
The indications for percutaneous endoscopic gastrostomy (PEG) tube placement in a patient with metastatic cancer and intestinal obstruction include:
- Decompression of malignant gastrointestinal obstructions 2, 3
- Palliation of symptoms such as nausea and vomiting caused by bowel obstruction 3, 4
- Provision of enteral nutrition for terminal malignancies of the upper gastrointestinal tract 4
- Relief of abdominal pain and discomfort associated with intestinal obstruction 2
Patient Selection
Patient selection for PEG tube placement is crucial, and the decision to place a PEG tube should be based on a thorough risk-benefit analysis, taking into account the patient's overall health status, tumor stage, and potential benefits of the procedure 5, 4.
- Patients with advanced tumor stage and high American Society of Anesthesiologist physical status score may be at higher risk of poor outcomes following PEG tube placement 4
- Patients with metastatic gastric cancer and peritoneal carcinomatosis may benefit from PEG tube placement for palliation of symptoms 2, 6
Alternative Procedures
In some cases, alternative procedures such as percutaneous transesophageal gastrostomy/jejunostomy (PTEG/J) may be considered for patients who are not candidates for PEG tube placement 6.
- PTEG/J is a safe and effective alternative to standard percutaneous gastrostomy/jejunostomy tube placement for decompression of bowel obstruction or feeding in appropriately selected patients 6