Drainage Percutaneous Endoscopic Gastrostomy for Malignant Bowel Obstruction in Gastrointestinal Cancers: Prognosis and Implications for Timing of Palliative Intervention

Abstract

Background: Malignant bowel obstruction (MBO) is a frequent complication in patients with advanced solid tumors. Palliative relief may be achieved by the use of a drainage percutaneous endoscopic gastrostomy (dPEG) tube, although optimal timing of placement remains unknown.

Objectives: To determine median survival after diagnosis of MBO and dPEG placement, factors associated with worse survival in MBO, factors associated with receipt of dPEG, and association of timing of dPEG placement on survival.

Methods: This observational retrospective cohort study examined 439 patients with MBO on a gastrointestinal medical oncology inpatient service. Patients were characterized by age, gender, race, primary cancer type, length of stay, readmission, complications (aspiration pneumonia or bowel perforation), and receipt of dPEG. Select factors were analyzed to examine overall survival (OS) and dPEG placement.

Results: Median survival from diagnosis of first MBO was 2.5 months. Median survival after dPEG placement was 37 days. In univariate analysis, dPEG placement, complications, longer length of stay, and readmissions were significantly associated with worse OS. Receipt of dPEG was significantly associated with younger age, longer length of stay at first admission, and shorter interval to readmission. In patients who received dPEG, longer interval from MBO diagnosis to dPEG placement did not affect OS.

Conclusion: We found that prognosis following diagnosis of MBO in patients with gastrointestinal malignancies remains poor. Our data suggest that timing of dPEG placement in MBO does not affect OS and, therefore, earlier intervention with this procedure may allow earlier and prolonged palliative relief.

Keywords: drainage percutaneous endoscopic gastrostomy; gastrointestinal malignancy; malignant bowel obstruction.

FIG. 1.

Kaplan-Meier survival curve for patients from diagnosis of first MBO (n = 439). There were 343 deaths. Median survival was 2.5 months (95% CI = 2.2–3.4). Median follow-up time for survivors was 13 months. MBO, malignant bowel obstruction.

FIG. 2.

Kaplan-Meier survival curve for patients with MBO who received dPEG (n = 121). There were 103 deaths. Median survival was 1.2 months (95% CI = 1.0–1.5). Median follow-up time for survivors was 0.2 months. dPEG, drainage percutaneous endoscopic gastrostomy.