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2022-RA-1043-ESGO CT-guided percutenous radiologic gastrostomy in heavily pretreated patients with late stage ovarian cancer: -the charité experiences-
  1. Emel Canaz1,
  2. Timo Alexander Auer2,
  3. Bernhard Gebauer2 and
  4. Jalid Sehouli1
  1. 1Department of Gynecology, Charité Comprehensive Cancer Center, Charité Medical University of Berlin, Berlin, Germany
  2. 2Department of Radiology, Charité Medical University of Berlin, Berlin, Germany


Introduction/Background Peritoneal carcinomatosis-associated ileus is frequent in advanced-recurrent ovarian/peritoneal/fallopian cancer and affects the quality of life due to severe symptoms of obstruction.CT-guided insertion of percutaneous gastrostomy (CT-PG) is a new minimal-invasive treatment option within the palliative management of gynaecological cancer patients.

Methodology Based on retrospective analysis we evaluated 18 patients undergoing percutaneous radiologic gastrostomy between September/2015 and April/2022. Clinical characteristics,complications, symptom-relief,need of secondary interventions and surgery for ileus,ability of receiving chemotherapy and mortality were identified.CT-guided gastrostomy was applied by Seldinger technique in local anesthesia.

Results The indication of CT-PG was peritoneal carcinomatosis-associated ileus in all patients. 15-patients had already undergone a frustrating endoscopic gastrostomy (PEG) placement or ileus operation prior CT-PG insertion.CT-PG could be successfully placed at 14 patients without any major interventional complication other than a local bleeding which was conservatively managed. The commonly observed metabolic complication after insertion was hypokalaemia requiring parenteral substitution. Symptom relief:10 of 14 patients who had successful CT-PG showed considerable symptom relief without need of any other subsequent invasive interventions other than one CT-PG re-insertion. Almost in all patients (13) surgery for ileus could be safely omitted.Only 3 patients needed additional PEG-insertion by gastroscopy due to inefficient flow-rate of radiologically inserted gastric-tube.Prognosis: 30-days mortality including patients who lost-to-follow-up in all intention-to-threat-population was 72% (13/18) with observed 5-events. Mean hospital stay after successful placement was 9.9 days(2–27 days). Chemotherapy could be administrated in 3 patients; however only 1 patient with primary diagnosis could receive 3-cycles of neoadjuvant chemotherapy.All other patients had been managed according to best-supportive-care principles due to high frailty and were placed on hospice/palliative station shortly after receiving gastrostomy.

Abstract 2022-RA-1043-ESGO Table 1

Conclusion The CT-PG is minimal invasive, safe, highly symptom-oriented palliative procedure in advanced/recurred peritoneal cancer. CT-PG procedure should be a routine instrument in the palliative management of bowel obstruction in patients with heavily-pretreated ovarian cancer.

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