Gastrointestinal Interventions

Session: Educational Exhibit Presentations - Station 4: Gastrointestinal Interventions

Malignant Bowel Obstruction: A Pictorial Guide to Advanced Interventional Techniques

Monday, March 6, 2023

5:05 PM – 5:10 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

MM

Maria Mitry, MD

Resident
New York Presbyterian-Weill Cornell

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Daniel J. Holzwanger, MD (he/him/his)

Assistant Professor
Weill Cornell Medicine
JY

Jenny J. Yan, MD

Resident
New York Presbyterian - Weill Cornell
Bradley B. Pua

Associate Professor of Radiology, Division Chief
New York Presbyterian - Weill Cornell Medical College
JM

Jeffrey Milsom, n/a

Professor of Surgery
Weill Cornell Medicine

Disclosure(s):

Maria Mitry, MD: No financial relationships to disclose

Daniel J. Holzwanger, MD: No financial relationships to disclose

Jenny J. Yan, MD: No financial relationships to disclose

Bradley B. Pua: No financial relationships to disclose

Learning Objectives:

Review the pathophysiology and management of malignant bowel obstruction.

Demonstrate interventional strategies for enteral access along the alimentary tract.

Illustrate advanced techniques for enteral access and palliation using a case-based approach.

Background:

Malignant bowel obstruction (MBO) is a source of morbidity and mortality in patients with abdominopelvic cancers. These patients can present in acute distress with nausea, vomiting, and pain{1}. MBO also contributes to poor nutrition which can exclude patients from oncologic therapy. This complex problem requires multimodal treatment with attention to the patients’ goals of care. Surgery is reserved for patients with good functional status and many cannot receive palliative surgery{2}. Interventional techniques can instead be used to provide patients with meaningful improvements in quality of life.

Clinical Findings/Procedure Details:

Despite medical management, many patients with MBO have recurrent symptoms and a suboptimal quality of life {1}. Placement of a gastrostomy tube is a safe and effective approach to palliate obstructive symptoms, however, MBO patients may have contraindications to standard gastrostomy placement such as peritoneal carcinomatosis, ascites, or altered anatomy{3}. Additionally, nutrition cannot be effectively administered through a gastrostomy tube in the setting of downstream obstruction. This exhibit provides a pictorial guide of strategies for obtaining access along the alimentary tract including trans-esophageal gastrostomy, gastrostomy, and jejunostomy tube placement. We showcase the use of ultrasound, Cone Beam CT, and CT guidance for troubleshooting challenging situations, as well as highlight the use of needle guidance software under fluoroscopy for precise enteral access to facilitate palliation.

Conclusion and/or Teaching Points:

Malignant bowel obstruction is a challenging clinical scenario responsible for significant morbidity and mortality in cancer patients. Interventionalists can provide palliation and nutritional support for these patients, however, standard gastrostomy tube placement is sometimes not possible or sufficient. This exhibit reviews the pathophysiology and management of MBO and uses a case-based approach to illustrate obtaining access along the alimentary tract while using a variety of imaging techniques beyond standard fluoroscopy.