Endosonography guided Coloenterostomy for Palliative Management of Peritoneal Carcinomatosis

Abstract

Background and aims: Small-bowel ileus (SBI) accompanying peritoneal carcinomatosis is often decisive for the prognosis. Conventional palliative care procedures deliver unsatisfying results. Our purpose was to evaluate the impact of endosonographic coloenterostomy (CE) on symptoms, oncologic management, Quality of Life (QoL), and survival.

Methods: After screening, 17 patients with various peritoneally metastasized neoplasms suffering from SBI were treated by CE. Biometrics, imaging, technical and clinical data, symptoms, QoL by EORTC_QLQ_C30, adverse events and the ability to tolerate oncologic treatment and enteral nutrition were recorded at predefined time points and compared to a propensity score matched historical cohort (n=29) that had been treated with percutaneous endoscopic gastrostomy (PEG) for the same indication.

Results: CE was technically and clinically successful in 16/17 (94.0%). Clinical symptoms (vomiting, abdominal pain, stool frequency) as well as QoL improved significantly. Enteral nutrition was possible in 14/17 (82.3%) patients. Mean follow-up time was 83 days (range 2 to 287). 9/17 patients (53.0%) could be re-exposed to systemic oncologic treatment and 6/7 (85.0%) of patients requiring oral opioid-based pain medication could receive it again. As compared to the cohort treated with PEG, there was a significant benefit in symptom-controlled survival (5 vs. 57 days, p<0.001) as well as in overall survival (14 vs. 86 days, p<0.001) irrespective of tumour entity.

Conclusion: EUS-guided CE for palliative management of SBI caused by peritoneal carcinomatosis is feasible and safe. The intervention boasts a high clinical success rate with immediate symptom relief and significant improvement of symptom-compensated and overall survival.

Keywords: Coloenterostomy; Endosonography; peritoneal carcinomatosis; small bowel ileus.