Purpose：Although ammonia shows a high due to advanced liver failure and the development of portal vein collateral circulation, there are few reports on ammonia in terminal stage of cancer. Therefore, the blood ammonia was measured against terminally ill cancer patients were studied retrospectively. Methods：For 80 cases who were admitted to the hospital for the purpose of palliative care, measured the blood ammonia at the time of admission, we have studied cancer species, gender, age, survival period, HbA1c, albumin, aspartate aminotransferase, alanine aminotransferase, total bilirubin, alkaline phosphatase, blood urea nitrogen, prothrombin activity, estimated glomerular filtration rate, C-reactive protein, hematocrit, presence or absence of liver metastases, presence or absence of opioid, laxative use, L3 level psoas major muscle area in ammonia high-value group and the normal group. Results：Hyperammonemia in terminally ill cancer patients in average survival time 41.6 days was observed in 21.3％. The significant differences in gender and liver metastasis in univariate analysis, liver metastases were extracted in the logistic regression. Conclusion：Cancer terminally ill patients with liver metastases were significantly higher to exhibit hyperammonemia in this study.

Purpose: We report an advanced pancreatic cancer case with duodenal obstruction successfully treated with percutaneous endoscopic gastrostomy (PEG). Our team, with a common understanding based on ethical considerations, determined how to treat this patient and devised a technically advanced PEG.
Case report: A woman in her 80s with advanced pancreatic cancer received best supportive care. However, she developed duodenal obstruction and could not eat. Therefore, we placed a PEG for decompression based on ethical considerations. We were careful to avoid gastrostomy tube obstruction or peritonitis caused by regurgitation of stomach contents. Her quality of life (QOL) improved when she regained the ability to eat and she returned home.
Conclusion: As to the ethical considerations, a conference the 4 contingency table of team－based clinical ethics was found to be effective. The QOL of this patient improved when ingestible food or PEG for decompression was applied.