Percutaneous endoscopic duodenostomy: the relief of obstruction in advanced gastric carcinoma

Nausea and vomiting in patients with advanced gastric malignancy and mechan ical obstruction are distressing and difficult to manage. We describe a pat ient with linitis plastica and gastric stasis who was treated with a percut aneous endoscopic duodenostomy as the stomach could not be used for percuta neous endoscopic gastrostomy (PEG) formation. A Conflo(TM) PEG tube was ins erted into the second part of the duodenum using the Ponsky-Gauderer techni que without complication. The patient experienced excellent symptomatic rel ief and tolerated enteral nutrition extremely well, regaining some weight. This manoeuvre can produce effective symptom palliation allowing the patien t to be managed at home during the terminal phase of their illness.