Percutaneous Trans-Esophageal Gastro-tubing（PTEG）の有用性―PEG不能例における経管栄養法および癌性腹膜炎による消化管閉塞症状緩和におけるPalliation手術として
Usefulness of Percutaneous Transesophageal Gastro-tubing as Palliative Treatment for Peritoneal Carcinomatosis and Palliative Surgery for Gastrointestinal Obstruction
1Surgery for Organ Function and Biological Regulation, Graduate School of Medicine, Nippon Medical School
2Division of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital
Historically, malignant gastrointestinal obstruction has been treated with surgical gastrostomy, percutaneous endoscopic gastrostomy (PEG), or nasogastric decompression. Of these treatments, nasogastric tubes are effective and the least invasive, but they are not feasible for long-term use. Surgical gastrostomy is invasive and may be poorly tolerated by debilitated patients, and PEG may also be contraindicated in these patients; Critically ill patients with advanced gastric carcinoma or abdominal recurrence require palliative treatment with best supportive care. Decompression of the malignant obstruction arising from gastric juice, bile, intestinal discharge, or unabsorbed beverages drunk for personal satisfaction is important to quality of life. Recently, a novel technique, percutaneous transesophageal gastro-tubing (PTEG), has been introduced for decompression of malignant obstruction. PTEG was developed as an esophagostomy method to drain gastrointestinal contents, especially in patients who have undergone total or subtotal gastrectomy but cannot undergo PEG or drainage with gastrointestinal tube for peritonitis carcinomatosis. Indications for PTEG include status after gastrectomy, peritonitis carcinomatosis with intestinal obstruction, excessive ascites in the abdominal cavity, and status on long-term drainage by nasogastric tube. Benefits of PTEG include better quality of life; prevention of respiratory complications; long-term decompression, especially for ileus status using PTEG long tubing; and the possibility of drinking or eating water-soluble substances during continuous aspiration of gastrointestinal contents. Here, we describe the successful placement of PTEGs in 29 patients, including 19 with gastric cancer, 5 with ovarian cancer, 3 with colorectal cancer, and 2 with pancreatic cancer. PTEG alleviated the symptoms of obstruction in all 29 patients. Almost all patients were able to drink beverages. Eight of the 29 patients were temporarily discharged with no subsequent complications, 2 of whom were treated with outpatient hyperalimentation over 6 months. PTEG is a safe and effective technique for decompression of malignant gastrointestinal obstruction and is also useful for the management of tube feeding, which is contraindicated in patients receiving PEG procedures, including patients who have undergone gastrectomy and those with massive ascites.
日医大医会誌 2007; 3(3), 128-135
percutaneous transesophageal gastro-tubing, peritoneal carcinomatosis, palliation surgery, gastrointestinal obstruction, tube feeding
Shunji Kato, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku 113-8603, Japan