Prospective Study May Clarify PTEG Benefits in Malignant Bowel Obstruction

In a conversation with CancerNetwork^®, Thinzar Min Lwin, MD, MS, discussed the potential next steps for researching the use of percutaneous transesophageal gastrostomy (PTEG) for patients with malignant bowel obstruction. Findings from a study she presented at the 2025 Society of Surgical Oncology Annual Meeting demonstrated technical success with limited complications and moderate durability when using PTEG for this patient population.

According to Lwin, a gastrointestinal cancer surgical oncologist and assistant clinical professor in the Division of Surgical Oncology of the Department of Surgery at City of Hope in Duarte, California, future work may focus on clarifying the symptoms that patients may experience following tube placement. She also highlighted the possibility of evaluating PTEG as part of a prospective study, although she posed a question regarding the appropriateness of including patients with malignant bowel obstruction in a multi-arm, interventional trial.

Transcript:

This was a retrospective study, so this led to a framework for us to be able to study [PTEG] in a prospective manner. At the time, we were not able to evaluate whether the quality and symptom improvement was present. We suspect that is the case, and right now, we are going to be working on setting up a study to further evaluate this. There have been studies from a group in Japan and an interventional radiology group at the Mayo Clinic that have studied this, and they also show similar and comparable technical success and at similar mean duration of tube use.² Our series is comparable, but one of the things that we’d like to be better able to characterize is what the symptoms are once this tube is placed because, among cancer care providers, there are different perceptions of this type of tube. Some patients hate it because there’s a tube at the neck, but then the alternative is to have a tube in the face and in the nose. Neither is great, but in that setting, what is better? Is less more in this case, given that patients are at the end of life? Could symptom management be optimized?

This would lead us to study this topic in a prospective manner, but [we are] also considering [whether] this would be an appropriate patient population to consider an interventional study where they get [randomly assigned] to any of the 3 options. We don’t know, and it’s difficult because patients come to us with many different reasons why these tubes are needed, but it would be valuable information for us to provide our [patients near] end of life—who [have] so much uncertainty in the setting of their malignant bowel obstruction—some data as to which course might be best.

References

1. Olson K, Boas FE, Liu B, Trisal V, Lwin T. Percutaneous transesophageal gastrostomy as an alternative approach for palliative decompression of malignant bowel obstruction. Presented at the 2025 Society of Surgical Oncology Annual Meeting. March 27-29, 2025; Tampa, FL. Abstract P435.
2. Rotellini-Coltvet L, Wallace A, Saini G, et al. Percutaneous transesophageal gastrostomy: procedural technique and outcomes. J Vasc Interv Radiol. 2023;34(11):1901-1907. doi:10.1016/j.jvir.2023.06.040.