Endosonography-guided coloenterostomy for palliative management of peritoneal carcinomatosis (with video)

Small-bowel ileus (SBI) accompanying peritoneal carcinomatosis is often decisive for the prognosis. Conventional palliative care procedures deliver unsatisfying results. Our purpose was to evaluate the impact of endosonographic coloenterostomy (CE) on symptoms, oncologic management, quality of life (QoL), and survival.

After screening, 17 patients with various peritoneally metastasized neoplasms who had SBI were treated by CE. Biometrics, imaging, technical and clinical data, symptoms, QoL by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), adverse events, and the ability to tolerate oncologic treatment and enteral nutrition were recorded at predefined time points and compared to a propensity score-matched historical cohort (n = 29) that had been treated with percutaneous endoscopic gastrostomy (PEG) for the same indication.

CE was technically and clinically successful in 16 of 17 patients (94.0%). Clinical symptoms (vomiting, abdominal pain, stool frequency) as well as QoL improved significantly. Enteral nutrition was possible in 14 of 17 patients (82.3%). Mean follow-up time was 83 days (range 2-287). Nine of 17 patients (53.0%) could be re-exposed to systemic oncologic treatment, and 6 of the 7 patients (85.0%) requiring oral opioid-based pain medication could receive it again. Compared with the cohort treated with PEG, there was a significant benefit in symptom-controlled survival (5 vs 57 days, P < .001) as well as in overall survival (14 vs 86 days, P < .001) irrespective of tumor entity.

EUS-guided CE for palliative management of SBI caused by peritoneal carcinomatosis is feasible and safe. The intervention boasts a high clinical success rate with immediate symptom relief and significant improvement of symptom-compensated and overall survival.