Abstract No. 227 - Percutaneous transesophageal gastrostomy (PTEG): indications, technique, and outcomes

Abstract

PTEG technique is a rare palliative procedure performed in patients with a contraindication to percutaneous gastrostomy.We sought to evaluate our experience at a tertiary care center in 14 patients. This IRB approved, HIPAA-compliant study involved a search of the department’s electronic database to identify all PTEG procedures from 2014-2016.Electronic medical records were used to identify demographics, clinical history, cross-sectional imaging and outcomes for each patient.All available CT, US and procedural fluoroscopy images were reviewed to evaluate variations in technique.Procedures were performed under general anesthesia for airway protection;a 20 mm angioplasty balloon was used as a target for percutaneous access of the esophagus for placement of a 45cm,14F multipurpose drain. Between 2014-2016, PTEG was attempted in 14 patients (7M,7F) with an average age of 53(range 27-72) for gastric venting from malignant bowel obstruction.Average ECOG scores were 2 (range 1-4).Patients had metastatic disease originating from the ovary (28.7%), stomach (28.7%), pancreas (7.1%), liver (7.1%), colon (7.1%), appendix (7.1%), small bowel (7.1%), and lung (7.1%).The most common indication was peritoneal carcinomatosis (57.2%) followed by ascites (35.7%) and invasive gastric cancer (7.1%).Technical success of PTEG was 93% (n = 13).In 1 patient, fibrotic changes due to radiation therapy precluded access to the esophagus.Intraprocedural complication included aspiration during esophageal balloon inflation (n = 2; 15.4%).Immediate post-PTEG symptoms included throat pain (n = 5; 36%) which was resolved with oral viscous lidocaine.Long-term complications (n = 3; 21%)included occlusion of the PTEG (n = 1), aspiration (n = 1) and PTEG site cutaneous infection (n = 1).There was 1 death resulting from aspiration pneumonitis.No association between ECOG score and major/minor complications (p>0.05).Using the Edmonton Symptom Assessment Scale (ESAS)and the Karnofsky Performance Scale, patency rates and relief of obstructive symptoms were 100% at 7 and 14 days post-procedure (p<0.05). PTEG can provide dramatic symptomatic relief to palliative patients; ESAS and KPS scores were 100% up to 14 days post-placement.