Alwali Ahmed, Schafmayer Clemens
Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery, Rostock University Medical Center, 18057 Rostock, Germany.
Cancers (Basel). 2025 Apr 10;17(8):1287. doi: 10.3390/cancers17081287.
Malignant bowel obstruction (MBO) is a common and distressing complication in advanced gastrointestinal cancers, significantly impacting patients' quality of life. When conservative management fails, palliative decompression is essential to relieve symptoms such as nausea, vomiting, and abdominal distension. Venting gastrostomy is the most established method; however, anatomical challenges may necessitate alternative percutaneous approaches.
This narrative review aims to provide a comprehensive overview of percutaneous gastrostomy techniques for palliative gastrointestinal decompression, including percutaneous endoscopic gastrostomy (PEG), interdisciplinary imaging-guided percutaneous or transhepatic gastrostomy, and percutaneous transesophageal gastrostomy (PTEG).
A literature review was conducted to evaluate the indications, techniques, efficacy, and complications associated with these procedures. The role of a multidisciplinary approach, incorporating radiologic, endoscopic, and palliative care expertise, was also explored.
PEG remains the gold standard for venting gastrostomy, achieving symptom relief in up to 92% of cases, with a low complication rate. However, interdisciplinary imaging-guided percutaneous or transhepatic gastrostomy offers a viable alternative for patients with surgically altered anatomy or difficult percutaneous access. PTEG, a newer technique, has demonstrated high technical success and symptom improvement, particularly in patients with extensive peritoneal carcinomatosis or massive ascites, where transabdominal approaches are not feasible.
Palliative percutaneous decompression provides effective symptom relief in advanced gastrointestinal cancer. The choice of technique should be individualized based on patient anatomy, clinical condition, and resource availability. A multidisciplinary approach remains crucial in tailoring decompression strategies to improve the quality of life in end-stage malignancies.
恶性肠梗阻（MBO）是晚期胃肠道癌症常见且令人痛苦的并发症，严重影响患者生活质量。保守治疗失败时，姑息性减压对于缓解恶心、呕吐和腹胀等症状至关重要。胃造口术是最成熟的方法；然而，解剖结构方面的挑战可能需要采用其他经皮途径。
本叙述性综述旨在全面概述用于姑息性胃肠减压的经皮胃造口术技术，包括经皮内镜下胃造口术（PEG）、多学科影像引导下经皮或经肝胃造口术以及经皮经食管胃造口术（PTEG）。
进行文献综述以评估这些手术的适应证、技术、疗效及相关并发症。还探讨了多学科方法（包括放射学、内镜学和姑息治疗专业知识）的作用。
PEG仍然是胃造口减压的金标准，高达92%的病例症状得到缓解，并发症发生率低。然而，多学科影像引导下经皮或经肝胃造口术为解剖结构经手术改变或经皮穿刺困难的患者提供了可行的替代方法。PTEG作为一种较新的技术，已显示出较高的技术成功率和症状改善效果，特别是在广泛腹膜转移癌或大量腹水患者中，经腹途径不可行时。
姑息性经皮减压可为晚期胃肠道癌症有效缓解症状。技术选择应根据患者解剖结构、临床状况和资源可用性个体化。多学科方法对于制定减压策略以改善终末期恶性肿瘤患者生活质量仍然至关重要。
