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Chang VT, Sandifer C, Zhong F. GI Symptoms in Pancreatic Cancer. Clin Colorectal Cancer 2023; 22:24-33. [PMID: 36623952 DOI: 10.1016/j.clcc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/21/2022] [Indexed: 12/31/2022]
Abstract
This review will apply a multidisciplinary approach to GI symptoms with attention to symptom assessment (instruments and qualitative aspects), differential diagnosis, and recent findings relevant to management of symptoms and underlying diseases. We conclude that further development of supportive interventions for GI symptoms for both patient and caregivers has the potential to reduce distress from GI symptoms, and anticipate better symptom control with advances in scientific knowledge and improvement of the evidence base.
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Affiliation(s)
- Victor T Chang
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ.
| | | | - Fengming Zhong
- Section Hematology Oncology (111), VA New Jersey Health Care System, East Orange, NJ; Department of Medicine, Rutgers - New Jersey Medical School, Newark, NJ
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Segger L, Auer TA, Fleckenstein F, Fehrenbach U, Federico Torsello G, Frisch A, Jonczyk M, Hamm B, Gebauer B. CT fluoroscopy-guided percutaneous gastrostomy (CT-PG) – A single center experience in 233 patients. Eur J Radiol 2022; 152:110333. [DOI: 10.1016/j.ejrad.2022.110333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
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Litwin RJ, Tam AL, Sheth RA, Yevich SM, Chan JL, Jazaeri AA, Halm JK, Gupta S, Huang SY. Safety and efficacy of percutaneous transabdominal and transesophageal decompression gastric catheters for palliation of malignant bowel obstruction. Abdom Radiol (NY) 2021; 46:4489-4498. [PMID: 33999283 DOI: 10.1007/s00261-021-03115-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/27/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the safety and primary technical success rate of gastric decompression via percutaneous transabdominal gastrostomy (PTAG) or percutaneous transesophageal gastric (PTEG) catheter placement for management of malignant bowel obstruction (MBO). A secondary purpose was to evaluate the safety and success rate for PTAG catheter placement in patients with both MBO and ascites. METHODS A single-institution retrospective review of 385 patients who underwent attempted decompression gastric catheter placement from March 2013 to August 2018 was performed. Medical records and imaging studies were reviewed. A subgroup of patients with concomitant MBO and ascites were identified. The primary outcome measures were procedural technical success and procedural complications. RESULTS 394 decompression gastrostomy catheters were attempted from 2013 to 2018, n = 353 PTAG and n = 41 PTEG. The success rate was 95.5% (n = 337 of 353) for PTAG and 97.6% (n = 40 of 41) for PTEG. There were 63 total complications involving 47 (13.9%) patients following PTAG and 13 total complications involving 9 (22.5%) patients following PTEG, P = 0.16. For the subgroup of patients with MBO and ascites, the success rate was 94.8% (n = 182 of 192 patients), and there were 20 complications involving 17 (12.9%) of 132 patients. CONCLUSION Gastric decompression for patients with MBO via PTAG or PTEG catheter placement is associated with high success rates and low complications.
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Affiliation(s)
- Robert J Litwin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77401, USA
| | - Alda L Tam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77401, USA
| | - Rahul A Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77401, USA
| | - Steven M Yevich
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77401, USA
| | - Johanna L Chan
- Department of Medicine, Section of Gastroenterology, Baylor College of Medicine, 720 Cambridge St, 8th floor, Suite 8B, Houston, TX, 77030, USA
| | - Amir A Jazaeri
- Department of Gynecology Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77401, USA
| | - Josiah K Halm
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77401, USA
| | - Sanjay Gupta
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77401, USA
| | - Steven Y Huang
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1471, Houston, TX, 77401, USA.
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Bleicher J, Lambert LA. A Palliative Approach to Management of Peritoneal Carcinomatosis and Malignant Ascites. Surg Oncol Clin N Am 2021; 30:475-490. [PMID: 34053663 DOI: 10.1016/j.soc.2021.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In addition to severe, life-limiting complications such as malignant bowel obstruction, fistulae, and malignant ascites, peritoneal carcinomatosis frequently causes life-impacting symptoms such as pain, nausea, anorexia, cachexia, and fatigue. A variety of medical, interventional, and surgical therapies are now available for management of both complications and symptoms. Although surgery in this population is often associated with a relatively high risk of morbidity and mortality, operative intervention can offer effective palliative treatment in appropriately selected patients. Early involvement of palliative care specialists as part of a multidisciplinary team is essential to providing optimal, holistic care of patients with peritoneal carcinomatosis.
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Affiliation(s)
- Josh Bleicher
- Division of General Surgery, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Suite 6405, Salt Lake City, UT 84112, USA.
| | - Laura A Lambert
- Division of General Surgery, Huntsman Cancer Institute, University of Utah, 1950 Circle of Hope, Suite 6405, Salt Lake City, UT 84112, USA
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Shah I, Bhurwal A, Mehta H, Maas D, Koneru G, Cohen AS, Kadkhodayan KS. Trends and outcomes of percutaneous endoscopic gastrostomy in hospitalized patients with malignant and nonmalignant ascites: a nationwide population study. Ann Gastroenterol 2020; 33:656-660. [PMID: 33162742 PMCID: PMC7599344 DOI: 10.20524/aog.2020.0531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/15/2020] [Indexed: 01/07/2023] Open
Abstract
Background Patients with ascites resulting from chronic debilitating diseases often require non-oral enteral nutrition and undergo placement of a percutaneous endoscopic gastrostomy (PEG) tube. The aim of our study was to assess the nationwide trends and outcomes of PEG tube placement among patients with ascites. Methods Using the Nationwide Inpatient Sample (NIS), we conducted a retrospective analysis of adult patients (≥18 years) who underwent PEG tube placement (n=789,167) from 2010-2014. We divided these patients into 2 groups: with or without ascites. We compared demographics, complications, and in-hospital outcomes between the groups. STATA-13 was used for statistical analysis. Statistical significance was assigned at P<0.05. Results Patients with ascites who underwent PEG tube placement were found to have a significantly higher rate of complications, including peritonitis (7.52 vs. 0.72%; P<0.001), aspiration pneumonia (20.41 vs. 2.69%; P<0.001), hemoperitoneum (0.72 vs. 0.19%; P<0.001), procedure-related hemorrhage (1.69 vs. 0.9%; P<0.001) and esophageal perforation (0.51 vs. 0.47%; P<0.001). In addition, these patients also had higher in-hospital mortality (16.33% vs. 7.02%; P<0.001) despite having a relatively lower prevalence of comorbidities. Length of stay was longer in the ascites group (28.08 vs. 19.45 days; 0.001). Over the study period, however, we observed an increasing trend for PEG tube placement in hospitalized patients with ascites. Conclusion PEG tube placement in hospitalized patients with ascites is associated with significantly higher mortality, a longer stay, and more procedure-related complications.
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Affiliation(s)
- Ishani Shah
- Department of Medicine, Creighton University / St. Joseph's Hospital and Medical Center, Phoenix, AZ (Ishani Shah, Daniel Maas)
| | - Abhishek Bhurwal
- Department of Medicine, Division of Gastroenterology (Abhishek Bhurwal)
| | - Harsh Mehta
- Department of Medicine, Saint Barnabas Medical Center, Livingston, NJ (Harsh Mehta)
| | - Daniel Maas
- Department of Medicine, Creighton University / St. Joseph's Hospital and Medical Center, Phoenix, AZ (Ishani Shah, Daniel Maas)
| | - Gopala Koneru
- Department of Medicine, University of Cincinnati, Cincinnati, OH (Gopala Koneru)
| | - Aaron S Cohen
- Department of Gastroenterology, Valleywise Health (Aaron S. Cohen)
| | - Kambiz S Kadkhodayan
- Department of Medicine, Division of Gastroenterology, Creighton University/St. Joseph's Hospital and Medical Center, Phoenix, AZ (Kambiz S. Kadkhodayan), USA
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Gasparetto A, Rosenberg M, Hunter D, Golzarian J, D'Souza D. Percutaneous gastric tube placement: Comparison of trans-abdominal and trans-oral approach in patients with chronic ascites. Diagn Interv Imaging 2018; 100:25-29. [PMID: 30220588 DOI: 10.1016/j.diii.2018.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/28/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to compare the trans-abdominal (TA) and trans-oral (TO) approaches for fluoroscopic-guided gastrostomy tube placement in patients with chronic ascites. MATERIALS AND METHODS A 10-year review of clinical imaging and medical records at a single institution identified 29 patients with chronic recurrent ascites who underwent gastrostomy (GT) or gastro-jejunostomy tube (GJT) placement. In 22 patients (18 women, 4 men) aged from 22 to 76 years of age (mean age, 57.7±13.1 years), a GT or GJT was placed with the TO approach, and in 7 (7 women) from 31 to 86 years of age (mean age, 63±16.8 years) with the TA approach. RESULTS Technical success was 100% in both groups with one (1/22; 5%) immediate complication in the TO group. Fluoroscopy time was significantly greater in the TO group (P=0.002). Leakage of ascites was significantly more frequent in the TA group (P=0.04). There was no significant difference in bleeding or inflammation (P=0.14 and P=0.43, respectively). The cumulative tract related complication rate was significantly greater in the TA group (P=0.03). CONCLUSION Fluoroscopy times and the overall incidence of tract-related complications, in particular leakage of ascites from the stoma, are more frequent in patients in chronic ascites who underwent TA gastrostomy tube placement compared to those who underwent TO placement.
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Affiliation(s)
- A Gasparetto
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - M Rosenberg
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - D Hunter
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - J Golzarian
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States
| | - D D'Souza
- University of Minnesota, Department of Radiology, 420, Delaware St SE, 55455 Minneapolis, MN, United States.
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Miller ZA, Mohan P, Tartaglione R, Narayanan G. Bowel Obstruction: Decompressive Gastrostomies and Cecostomies. Semin Intervent Radiol 2017; 34:349-360. [PMID: 29249859 DOI: 10.1055/s-0037-1608706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Over the past 30 years, image-guided placement of gastrostomies and cecostomies for gastrointestinal decompression has developed into a safe and effective treatment for symptomatic bowel obstruction. Gastrostomies and cecostomies relieve patient symptoms, can prevent serious complications such as colonic perforation, and may bridge patients to more definitive treatment for the underlying cause of obstruction. This article will review the history of decompressive gastrostomies and cecostomies as well as the indications, contraindications, technique, complications, and outcomes of these procedures.
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Affiliation(s)
- Zoe A Miller
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
| | - Prasoon Mohan
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
| | - Robert Tartaglione
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
| | - Govindarajan Narayanan
- Department of Interventional Radiology, University of Miami-Miller School of Medicine, Miami, Florida
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