PD844 - PTEG VENTING ENABLING SYSTEMIC THERAPY IN SCIRRHOUS GASTRIC CANCER: A CASE REPORT

PD844

PTEG VENTING ENABLING SYSTEMIC THERAPY IN SCIRRHOUS GASTRIC CANCER: A CASE REPORT

K. Tsuboi^1,*, S. Song², T. Izumi¹, S. Inoue¹, N. Sakoi¹, S. Yasuoka¹, C. Shibata¹, K. Sato¹, M. Okamura¹, A. Sekioka¹, K. Toriguchi¹, T. Ito¹, S. Ota¹

¹Gastroenterological Surgery, ²Gastroenterology, Osaka Saiseikai-Noe Hospital, Osaka, Japan

Rationale: Percutaneous transesophageal gastrotubing (PTEG) was developed in Japan in 1994 as an alternative when percutaneous endoscopic gastrostomy (PEG) is not feasible, initially for long-term venting in malignant obstruction and later also for enteral nutrition. In Japan, PTEG is covered by public health insurance and supported by hands-on training and provider certification through the Japan Association for Percutaneous Trans-Esophageal Gastro-tubing (JAPTEG), while it is perceived to be less common in Europe. We demonstrate how PTEG venting with home enteral nutrition via jejunostomy can support systemic therapy despite malignant gastric outlet obstruction.

Methods: Retrospective single-case review in compliance with ethical standards. The presenting author is a JAPTEG Certified Physician Handling PTEG.

Results: A 78-year-old man weighing 40kg with scirrhous gastric cancer accompanied by peritoneal dissemination and multiple liver metastases developed marked gastric distension with poor oral intake. Nasogastric tube (NGT) reduced distension, but high output prevented NGT removal. Surgical bypass and PEG were not feasible because the entire stomach was involved. A jejunostomy was created on hospital day 19 for enteral nutrition. PTEG was placed on day 42 for long-term venting, enabling NGT removal. With preserved performance status, systemic therapy with S-1 plus oxaliplatin and pembrolizumab was initiated on day 52, after which the patient was discharged with home enteral nutrition (HEN) of 1200 kcal/day, which maintained his weight and activity level. Outpatient chemotherapy continued safely without serious complications.

Conclusion: We report a case of gastric cancer with outlet obstruction in which PTEG placement enabled systemic chemotherapy. When PEG or bypass are not feasible, PTEG venting with HEN via jejunostomy may enable active systemic therapy beyond palliation, potentially contributing to improved prognosis.

Disclosure of Interest: None declared