Radiologically-Inserted Gastrostomy — SCE Palliative Medicine MCQ

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HardGI SymptomsRadiologically-Inserted GastrostomySCE Palliative Medicine

A 70‑year‑old woman with advanced gastric cancer develops severe dysphagia to solids and liquids. Endoscopy shows a tight malignant stricture in the mid‑oesophagus. She is too frail for stenting under sedation. What alternative feeding route may be considered?

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Correct answer: E — Radiologically‑inserted gastrostomy (RIG)

In this frail patient with inoperable malignant oesophageal obstruction, RIG is the best option because it allows enteral feeding via percutaneous gastrostomy inserted under local anaesthesia and radiological guidance, avoiding sedation and bypassing the stricture. NICE CG32 supports gastrostomy for long‑term (>4 weeks) enteral feeding when the upper GI tract is inaccessible. Nasojejunal tubes cannot be reliably passed through an obstructed stricture and are not intended as permanent solutions. TPN carries higher risk and is inferior to enteral nutrition. Surgical jejunostomy requires general anaesthesia, which this patient cannot tolerate. Orogastric tube feeding does not bypass the obstruction and is temporary only.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer/palliative-care