Title: Which procedure is the best for drainage to ease nausea and vomiting due to pylorus obstruction with advanced gastric cancer: The comparison amoNG naso-gastric(NG) tube, Percutaneous Endoscopic Gastrostomy(PEG), and Percutaneous Transesophageal Gastrotubing(PTEG)
Abstract:
PTEG is the excellent and elaborate procedure for both administration way of nutrition and drainage for gastrointestinal obstruction as a palliative care, however, as for now, have not been spread around the world widely. Some reasons prevent on-site doctors from performing operations of PTEG, for example, 1) the procedure of PTEG might be more difficult than that of PEG, 2) the criteria of the indication for PTEG might be stricter than those for PEG, or 3) clinical cost for PTEG might be higher than that of PEG. All of them can be said misunderstanding. Regarding for 1) using rapture free balloon (RFB catheter), this technique is proved as safe as, or safer than PEG. Regarding for 2) for instance, hypoalbuminemia is a contraindication for PEG, however, PTEG can be performed under such malnutritional condition.
We think it is very important to dispel these misunderstandings from now on.
Firstly, naso-gastric tube, in merit, does not need any surgical procedure so with no surgical complication. However, patients cannot avoid discomfort feelings in their nasal and laryngeal parts, and what is the worse, its placement for long period leads to occur aspiration pneumonia. ESPEN guide line also said if period of naso-gastric tube placement is going to reach over four weeks, PEG should be planed.
Secondly, PEG is a better procedure from the point of patients’ discomfortable feeling. However, from the point of effectiveness of drainage, PEG was validated to be poor than that of PTEG in this research. As you know, PEG is placed in anterior wall of stomach. When patients lie in bed on supine position, PEG cannot drainage until the stomach become to be full with large amount of fluid. Before almost full stomach, little fluid is drainaged from PEG, so patients have likely vomited and aspirated some fluid from stomach to their lung unfortunately. To the contrary, PTEG is placed at the fundic position, on the posterior side of stomach, so before their stomach becomes full, drainage will start naturally. Fig.1 shows enough dose of drainage from Day 1. As the result, aspiration pneumonia won’t occur. From this point, naso-gastric tube also could drainage enough from Day 1, however, Table 1 showed the same occurrence rate with PEG, 50.0%. We speculate naso-gastric tube in the throat causes the difficulty of swallowing adequately.
For above these reasons, we select PTEG to get rid of the pain of severe patients with bowel obstruction due to advanced cancer. This time, we have investigated about the best procedure as a palliative care method for the severe patients with gastroenteral obstruction due to advanced cancer, compared with nasa-gastric tube, PEG, and PTEG. As shown in results, PTEG might be validated the most excellent tool for drainage to placate their discomfort of terminal malignant patients.
Audience Take Away Notes:
- To know new procedure of effective palliative method for terminal cancer patients
- To know alternative nutritional way instead of N-G tube and PEG
- To learn why such differences of the results would happen among each procedure
