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Venting Gastrostomy

Frances U Onyimba, John O Clarke
Gastroparesis is an increasing concern and options remain limited. Diagnosis hinges on recognition of delayed gastric emptying in the absence of mechanical obstruction. Nontransit studies evaluating gastric motility serve a complementary role and may help guide therapy. Treatment consists of a combination of lifestyle and dietary medication, medications (antiemetics, prokinetics, neuromodulators, and accommodation-enhancers), alternative and complementary therapy, endoscopic therapy (pyloric-directed therapy, temporary stimulation, jejunostomy, or venting gastrostomy) and surgical therapy (pyloroplasty, gastric electrical stimulation, gastrectomy)...
January 2019: Medical Clinics of North America
Richard D Urman, Elizabeth J Lilley, Marguerite Changala, Charlotta Lindvall, David L Hepner, Angela M Bader
BACKGROUND: Periprocedural providers are encountering more patients with code status limitations (CSLs) regarding their preferences for resuscitation and life-sustaining treatment who choose to undergo palliative procedures. Surgical and anesthesia guidelines for preprocedural reconsideration of CSLs have been available for several years, but it is not known whether they are being followed in practice. OBJECTIVE: We assessed compliance with existing guidelines for patients undergoing venting gastrostomy tube (VGT) for malignant bowel obstruction (MBO), serving as an example of a palliative procedure received by patients near the end of life...
August 2018: Journal of Palliative Medicine
Alison Phippen, Elaine Brennan, John Ealing, Samantha Kay, David Waterman
Dysphagia and weight loss are experienced by up to 80% of patients with motor neuron disease (MND). Enteral tube feeding can benefit these patients but side effects including fullness, bloating, diarrhoea and constipation are frequent and can lead to non-compliance. Changes in feed formulation, regimens and the use of prokinetic medication can help symptoms. We describe a case where the use of gastric pressure relief bags during enteral feeding improved symptoms of bloating in a hospice inpatient with MND. Symptoms recurred when these were not used, which were only partially relieved by manual venting of the gastrostomy tube...
September 2017: BMJ Supportive & Palliative Care
Elizabeth J Lilley, John W Scott, Joel E Goldberg, Christy E Cauley, Jennifer S Temel, Andrew S Epstein, Stuart R Lipsitz, Brittany L Smalls, Adil H Haider, Angela M Bader, Joel S Weissman, Zara Cooper
OBJECTIVE: To compare survival, readmissions, and end-of-life care after palliative procedures compared with medical management for malignancy-associated bowel obstruction (MBO). BACKGROUND: MBO is a late complication of intra-abdominal malignancy for which surgeons are frequently consulted. Decisions about palliative treatments, which include medical management, surgery, or venting gastrostomy tube (VGT), are hampered by the paucity of outcomes data relevant to patients approaching the end of life...
April 2018: Annals of Surgery
Ahmed M A Mohammed, Robert J Dennis
A patient with Prader-Willi Syndrome was admitted to the ICU with features of recurrent acute gastric dilatation, aspiration pneumonia and a massive pulmonary embolus. He was initially managed with intubation, assisted ventilation, intravenous fluids and anticoagulation. Decompression of the stomach was achieved with a nasogastric tube. After ventilator weaning, he did not tolerate the nasogastric intubation that led to a further episode of aspiration pneumonia as a result of non-resolving gastric dilatation...
2016: Journal of Surgical Case Reports
Timothy G DeEulis, Sriram Yennurajalingam
Malignant bowel obstruction (MBO) frequently defines the trajectory of end-stage ovarian cancer and results in severe physical and psychological distress in patients and their caregivers. Venting gastrostomy (VG) is an alternative to both prolonged medical therapy with nasogastric intubation and intestinal bypass/diversion for refractory MBO. Limited published data from large academic research centers support use of VG in patients with advanced ovarian cancer and MBO. In this case series, we describe supportive care outcomes in ovarian cancer patients with MBO receiving the effects of VG in a community setting...
August 2015: Journal of Palliative Medicine
Guillemette Laval, Blandine Marcelin-Benazech, Frédéric Guirimand, Laure Chauvenet, Laure Copel, Aurélie Durand, Eric Francois, Martine Gabolde, Pascale Mariani, Christine Rebischung, Vincent Servois, Eric Terrebonne, Catherine Arvieux
This article reports on the clinical practice guidelines developed by a multidisciplinary group working on the indications and uses of the various available treatment options for relieving intestinal obstruction or its symptoms in patients with peritoneal carcinomatosis. These guidelines are based on a literature review and expert opinion. The recommended strategy involves a clinical and radiological evaluation, of which CT of the abdomen is a crucial component. The results, together with an analysis of the prognostic criteria, are used to determine whether surgery or stenting is the best option...
July 2014: Journal of Pain and Symptom Management
Rachel B Issaka, David M Shapiro, Neehar D Parikh, Mary F Mulcahy, Srinadh Komanduri, John A Martin, Rajesh N Keswani
BACKGROUND AND STUDY AIMS: Obstructive symptoms are common in advanced malignancies. Venting percutaneous endoscopic gastrostomy (VPEG) tubes can be placed for palliation. The aim of this study was to determine the outcomes of VPEG placement in patients with advanced malignancy. METHODS: We retrospectively reviewed patients in whom a VPEG tube was attempted for a malignant indication from 1998 to 2010 at a tertiary care center. Clinical information, procedure details, and adverse events (AEs) were recorded...
May 2014: Surgical Endoscopy
Mikko P Pakarinen, Annika Kurvinen, Antti I Koivusalo, Tarja Ruuska, Heikki Mäkisalo, Hannu Jalanko, Risto J Rintala
AIM: The aim of this study was to characterize outcomes of children with severe intestinal motility disorders (IMD) requiring parenteral nutrition (PN). METHODS: Twenty consecutive children with primary IMD requiring long-term PN between 1984 and 2010 were included. Median (interquartile range) follow-up was 13.1 (5.2-20.1) years. Treatment, PN dependence, growth, nutritional status, liver function, and survival were assessed. RESULTS: Underlying etiology included chronic intestinal pseudo obstruction (CIPO; n=8) and Hirschsprung disease with extensive aganglionosis (n=12)...
February 2013: Journal of Pediatric Surgery
Elisabeth Diver, Owen O'Connor, Leslie Garrett, David Boruta, Annekathryn Goodman, Marcela Del Carmen, John Schorge, Peter Mueller, Whitfield Growdon
OBJECTIVE: The aim of the study is to review a single institution's experience with gastrostomy tubes (GTs) performed for malignant bowel obstruction from gynecologic cancers. METHODS: Women with gynecologic cancers who underwent venting GT placement from 2000 to 2008 were identified and clinical data were extracted. Logistic regression and spearman correlational coefficients were used to determine relationships between variables. Survival analysis was performed using the Kaplan-Meier method and a Cox proportional hazard model...
May 2013: Gynecologic Oncology
Michael Camilleri, Henry P Parkman, Mehnaz A Shafi, Thomas L Abell, Lauren Gerson
This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain. Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control...
January 2013: American Journal of Gastroenterology
David M Richards, Rajasekhar Tanikella, Gaurav Arora, Sushovan Guha, Alexander A Dekovich
BACKGROUND: Cancer patients benefit from percutaneous endoscopic gastrostomy (PEG) in many ways including nutritional support and venting in cases of malignant obstruction. Lack of high-quality studies with adequate follow-up has led to limited information regarding risk stratification and predictors of morbidity and mortality. AIMS: Elucidate predictors of complications and mortality with long-term follow-up in cancer patients undergoing PEG. METHOD: Retrospective review of all patients undergoing PEG placement at MD Anderson Cancer Center from January 1, 2004 to December 31, 2006...
March 2013: Digestive Diseases and Sciences
Colette Shaw, Roland L Bassett, Patricia S Fox, Kathleen M Schmeler, Michael J Overman, Michael J Wallace, Sanjay Gupta, Alda Tam
BACKGROUND: Fluoroscopic-guided placement of a percutaneous decompression gastrostomy tube (PDGT) is used to palliate patients with malignant bowel obstruction (MBO). We report our clinical experience in cases of MBO and ascites that were known to be technically difficult and at increased risk for complications after PDGT placement. METHODS: Between October 2005 and April 2010, a total of 89 consecutive oncology patients with MBO and ascites underwent at least one attempt at PDGT placement...
February 2013: Annals of Surgical Oncology
Keta L Keens, Ravindra S Date
Cholecystoduodenal fistula is a type of biliary enteric fistula that can occur as a result of chronic cholecystitis. The majority of cases are diagnosed and their subsequent management planned intraoperatively. Previous reports have focused on successful laparoscopic management. We report three cases of elective cholecystectomy that were diagnosed intraoperatively with a cholecystoduodenal fistula (CDF). The first two cases were managed laparoscopically. In case 3 further continuation of surgery would have subjected the patient to significant risk of further harm...
2012: BMJ Case Reports
Anouar Teriaky, Jamie Gregor, Nilesh Chande
BACKGROUND/AIM: Decompression of malignant gastrointestinal obstructions is an uncommon indication for percutaneous endoscopic gastrostomy (PEG) tubes. The purpose of this study is to determine the efficacy of venting PEG tubes in relieving nausea and vomiting and assessing complications associated with tube placement. PATIENTS AND METHODS: This study is a retrospective chart review of patients with PEG tubes placed to decompress malignant gastrointestinal obstructions between January 2005 and September 2010 by the gastroenterology service at our institute...
March 2012: Saudi Journal of Gastroenterology: Official Journal of the Saudi Gastroenterology Association
M Chitnis, C Lazarus, I Simango, M Elsen, C Van Rensburg, D Von Delft, L Tovell Trollope
African degenerative leiomyopathy (ADL) is a rare incurable disorder seen in African children, predominantly in southern and south-eastern Africa. ADL presents as chronic intestinal pseudo-obstruction. Management is traditionally conservative, with surgery restricted to the management of complications. We have placed Malone antegrade continence enema (MACE) stomas in the grossly dilated colon to vent accumulated gas and administer antegrade bowel enemas. This is done mainly for relief of gaseous distension and constipation in an attempt to provide symptomatic relief and improve quality of life...
March 14, 2011: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
David L Diehl, Alok K Jain, Bruce D Greenwald
There is an increasing use of cryotherapy in the gastrointestinal tract for ablation of a variety of lesions. There is only a single reported case of perforation with spray cryotherapy, which was in a patient with Marfan syndrome. In this report, we describe pneumoperitoneum in a patient with a percutaneous endoscopic gastrostomy tube undergoing cryoablation. It is postulated that barotrauma at the percutaneous endoscopic gastrostomy site led to the pneumoperitoneum, and this can occur even with apparently adequate gas-venting procedures...
June 2011: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Elisabeth A Dolan
Malignant bowel obstruction is common in individuals with intra-abdominal and pelvic malignancies and results in considerable suffering. Treatments target both the resolution of obstruction and symptom management. Emerging procedures include stents placement in the bowel to return patency and newer surgical procedures that are evolving to be less invasive. The use of medical interventions like corticosteroids, alone or in concert with additional drugs, can be utilized to achieve resolution of obstruction. Throughout treatment, it is important to also aggressively treat obstructive symptoms like pain and nausea/vomiting...
December 2011: American Journal of Hospice & Palliative Care
Anita Chakraborty, Debbie Selby, Kate Gardiner, Jeff Myers, Veronika Moravan, Frances Wright
CONTEXT: The management of malignant bowel obstruction (MBO) is often challenging and frequently involves multiple treatment modalities, including chemotherapy, surgery, stenting, and symptomatic medical management. OBJECTIVES: To describe the natural history of patients diagnosed with MBO who were admitted to a tertiary level hospital and followed by a multidisciplinary team that included medical oncologists, surgical oncologists, and palliative care specialists...
February 2011: Journal of Pain and Symptom Management
Michael Camilleri, Adil E Bharucha, Gianrico Farrugia
Recent evidence of the significant impact of gastroparesis on morbidity and mortality mandates optimized management of this condition. Gastroparesis affects nutritional state, and in diabetics it has deleterious effects on glycemic control and secondary effects on organs that increase mortality. First-line treatments include restoration of nutrition and medications (prokinetic and antiemetic). We review the epidemiology, pathophysiology, impact, natural history, time trends, and treatment of gastroparesis, focusing on diabetic gastroparesis...
January 2011: Clinical Gastroenterology and Hepatology
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