Dittrich Anne, Schubert Barbara, Kramer Michael, Lenz Felicitas, Kast Karin, Schuler Ulrich, Schuler Markus K
Department of Internal Medicine I, University Hospital Carl Gustav Carus Dresden, Technical University Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Department of Internal Medicine, St. Joseph-Stift Hospital Dresden, Wintergartenstraße 15/17, 01307, Dresden, Germany.
Support Care Cancer. 2017 Sep;25(9):2849-2856. doi: 10.1007/s00520-017-3700-1. Epub 2017 Apr 22.
Gastrointestinal obstruction presents many burdens for patients with end-stage abdominal cancer, such as nausea and vomiting. Few detailed data on the efficacy of a percutaneous endoscopic gastrostomy (PEG) for decompression exists. This retrospective cohort study investigates the quantity of symptom relief realized with PEG and the corresponding complications.
Chart reviews of 75 patients with malignant gastrointestinal obstruction, who received a PEG for decompression, were performed. Abstracted data includes symptoms (vomiting, nausea, abdominal pain) and medication up to 7 days before and after the intervention, complications, demographics, potential influencing factors and survival. Generalized estimating equations (GEE) models determined symptom reduction.
PEG decreased the mean frequency of vomiting per day from 2.2 (95% confidence interval (CI) 1.7-2.7) to 0.4 (95% CI 0.3-0.6) (p < 0.001). The probability of the occurrence of nausea on a given day was 80% (95% CI 74-85%) prior to the PEG placement and 40% (95% CI 34-47%) afterwards (p < 0.001). One hundred twelve complications were reported in 56 patients (none 19/75 patients (25%), minor 52/75 (69%), major 18/75 (24%)). Stomal leakage (18/75 patients), mild wound pain (17/75) and tube occlusion (13/75) occurred most frequently. The failure of the first attempt of the PEG placement (7/75) presented as the leading major complication.
The PEG for decompression significantly reduces vomiting and nausea in patients with malignant gastrointestinal obstruction (p < 0.001). Minor complications are common and should be discussed prior to the intervention. Nevertheless, the PEG appears to demonstrate prevailing benefits in comparison to the risks.
胃肠道梗阻给晚期腹部癌症患者带来诸多负担，如恶心和呕吐。关于经皮内镜下胃造口术（PEG）减压效果的详细数据很少。这项回顾性队列研究调查了PEG实现症状缓解的程度及相应并发症。
对75例因恶性胃肠道梗阻接受PEG减压的患者进行病历审查。提取的数据包括干预前后最多7天的症状（呕吐、恶心、腹痛）和用药情况、并发症、人口统计学资料、潜在影响因素及生存情况。采用广义估计方程（GEE）模型确定症状减轻情况。
PEG使每日平均呕吐频率从2.2次（95%置信区间[CI]1.7 - 2.7）降至0.4次（95%CI 0.3 - 0.6）（p < 0.001）。PEG置入前一天发生恶心的概率为80%（95%CI 74 - 85%），置入后为40%（95%CI 34 - 47%）（p < 0.001）。56例患者报告了112例并发症（无并发症19/75例患者[25%]，轻微并发症52/75例[69%]，严重并发症18/75例[24%]）。造口漏（18/75例患者）、轻度伤口疼痛（17/75例）和管道堵塞（13/75例）最为常见。PEG置入首次尝试失败（7/75例）是主要的严重并发症。
PEG减压显著降低了恶性胃肠道梗阻患者的呕吐和恶心症状（p < 0.001）。轻微并发症很常见，干预前应进行讨论。然而，与风险相比，PEG似乎显示出主要的益处。
