Jump to comment:

• Technical factors of venting gastrostomy and their impact on patient experience.
  Hans-Ulrich Laasch, Damian Mullan
  Published on: 6 March 2021

• Published on: 6 March 2021

  Technical factors of venting gastrostomy and their impact on patient experience.

  • Hans-Ulrich Laasch, Consultant Radiologist The Christie NHS Foundation Trust
  • Other Contributors:
    • Damian Mullan, Consultant Radiologist

  Dear Editor,
  We read with great interest the article by Curry et al. on the outcomes after venting gastro-/jejunostomy from our own institution.
  While venting gastrostomy has a potentially important role to play in cancer palliation, it is offered in only approximately 60% of UK centres. The outcome and patient experience is highly dependent on good tube function. Continuous decompression of the stomach and upper small bowel is essential to alleviate symptoms and stop the development of complications.
  Little is published on the technical aspects of the procedure, how to undertake this safely and what the requirements for patient selection and aftercare are. Would the authors please be so kind, as to provide some technical detail to guide the readership?
  To our knowledge there are no licensed devices for this purpose. What type of tubes did the authors review (push-PEGs +/- jejunal extension, G-tubes with gastropexy, gastrojejunostomy or transgastric jejunostomy tubes), what was the experience of 4-point gastropexy for GJ-tubes and what size was do they recommend to achieve adequate drainage, bearing in mind that balloon-retained silicone tubes have a much smaller inner lumen than polyurethane PEG tubes?
  Our attempts using 20Fr push-PEG tubes led to very poor patient experience, which has been improved by switching to gastro-jejunostomy tubes, as they achieve better drainage due accessing the fluid in the duodenum rather than in the stomach, we...

  Show More

  Dear Editor,
  We read with great interest the article by Curry et al. on the outcomes after venting gastro-/jejunostomy from our own institution.
  While venting gastrostomy has a potentially important role to play in cancer palliation, it is offered in only approximately 60% of UK centres. The outcome and patient experience is highly dependent on good tube function. Continuous decompression of the stomach and upper small bowel is essential to alleviate symptoms and stop the development of complications.
  Little is published on the technical aspects of the procedure, how to undertake this safely and what the requirements for patient selection and aftercare are. Would the authors please be so kind, as to provide some technical detail to guide the readership?
  To our knowledge there are no licensed devices for this purpose. What type of tubes did the authors review (push-PEGs +/- jejunal extension, G-tubes with gastropexy, gastrojejunostomy or transgastric jejunostomy tubes), what was the experience of 4-point gastropexy for GJ-tubes and what size was do they recommend to achieve adequate drainage, bearing in mind that balloon-retained silicone tubes have a much smaller inner lumen than polyurethane PEG tubes?
  Our attempts using 20Fr push-PEG tubes led to very poor patient experience, which has been improved by switching to gastro-jejunostomy tubes, as they achieve better drainage due accessing the fluid in the duodenum rather than in the stomach, were it can cause nausea, biliary gastritis, reflux and aspiration, notably in the supine position. However GJ-tubes are much more demanding in terms of tube maintenance. The title suggests that outcome of both types were assessed – could the authors’ please elaborate on the differences reported by patients and can one be recommended over the other?
  The introduction of the Enfit standard has resulted in additional problems with the connectors reducing flow and causing obstruction, and patients having difficulties obtaining matching drainage bags. This is proving such a problem that we are considering suspending this procedure. What advice do the authors have?
  Malignant bowel obstruction precludes the administration of oral contrast and it is frequently associated with large-volume ascites, which can result in debilitating leakage. What method was used to identify the colon during the procedure and how is co-existing ascites managed?
  In our experience patient selection and counselling is crucial. Patients – and indeed the referring team – rarely fully understand that the patient is limited to a comfort-based intake of fluids and requires additional parenteral nutrition. Leakage of gastric content is a frequent problem, leading to skin excoriation and break down of the peri-stomal tissues, which blights patients’ lives if not checked rapidly. “Infection” should be treated in the first instance with topical creams combining an appropriate antibiotic / antifungal and a steroid after a wound swab and culture, not with systemic antibiotics. We routinely apply an alginate (Flaminal Hydro, Flen Health, London, UK) for two weeks after the procedure to promote healing and reduce the risk of infection, and offer an open-accesss drop-in clinic for all gastrostomy patients. Do the authors’ have any advice for post-procedural wound care, which is crucial in reducing complications?
  What were the lessons learned from tubes “falling out” and how were these managed? In contrast to gastrostomy, gastro-jejunostomy catheters require image-guidance to be reintroduced into the duodenum.

  Hoping to be referenced in future projects that were designed collaboratively,
  Sincerely,
  The Christie Interventional Radiology Team

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top