PERCUTANEOUS ENDOSCOPIC GASTROENTEROSTOMY AND JEJUNAL EXTENSION FOR GASTRIC STASIS IN PANCREATIC-CARCINOMA

Gastric stasis in pancreatic cancer without mechanical obstruction is distressing and difficult to manage, We describe two patients who were treated by percutaneous endoscopic gastroenterostomy (PEG) combined w ith a jejunal extension. Both patients had pancreatic cancer and gastr ic stasis, with recurrent vomiting and no evidence of distal duodenal obstruction. They were unresponsive to high-dose prokinetic agents. In both cases a Bower-PEG feeding tube with jejunal extension was insert ed endoscopically, with clinical improvement. The technique has the ad vantages of permitting enteral feeding and allowing aspiration of uppe r gastrointestinal secretions between feeds, which produces symptomati c relief from nausea and vomiting. This manoeuvre can produce effectiv e palliation, perhaps allowing the patient to be managed at home durin g the terminal phase of their illness.