Outcomes after surgical venting gastrostomy tube placement in patients with malignant bowel obstruction.

Abstract

Venting gastrostomy tube placement is indicated for patients with malignant bowel obstructions related to advanced cancer. The aim of this study was to determine whether venting gastrostomy tube placement is associated with improvement in objective measures of quality of life and to examine factors associated with unsuccessful gastrostomy tube placement. We performed a retrospective cohort study of patients who underwent or had an attempted venting gastrostomy tube placement between 2015 and 2024. We compared patients' diet, episodes of emesis, and antiemetic requirements before and after gastrostomy tube placement. Of 3,701 gastrostomy tubes placed or attempted during the study period, 221 were venting gastrostomy tubes in patients with cancer. Venting gastrostomy tubes were successfully placed in 203 (91.9%) patients using endoscopic, open, or laparoscopic approaches, whereas placement was unsuccessful in 18 (8.1%) patients. Non-White race and the presence of ascites were significantly associated with failure of gastrostomy tube placement (relative risk, 2.88; P = .026 and relative risk, 3.03; P = .030, respectively). Among patients who underwent successful gastrostomy tube placement, there were significant advancements in diet from pre-gastrostomy tube placement to immediately post-gastrostomy tube placement to the day of discharge (P < .001). There were also significant decreases in daily episodes of emesis from pre-gastrostomy tube placement to post-gastrostomy tube placement (from a median of 0.5 to 0 episodes, P < .001) and daily antiemetic requirement (from a median of 2 to 0.5 doses, P < .001). Venting gastrostomy tube placement is associated with improvements in objective measures of quality of life. Larger studies will allow for risk adjustment to more clearly identify risk factors for failure of gastrostomy tube placement.