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 with a jejunal extension. Both patients had pancreatic cancer and gastric 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 inserted endoscopically, with clinical improvement. The technique has the advantages of permitting enteral feeding and allowing aspiration of upper gastrointestinal secretions between feeds, which produces symptomatic relief from nausea and vomiting. This manoeuvre can produce effective palliation, perhaps allowing the patient to be managed at home during the terminal phase of their illness.