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Review
. 2022 Mar 15;16(2):190-197.
doi: 10.5009/gnl210010.

Optimal Management of Gastric Outlet Obstruction in Unresectable Malignancies

Stephanie Lok Hang Cheung  1 , Anthony Yuen Bun Teoh  1
Affiliations
Review

Optimal Management of Gastric Outlet Obstruction in Unresectable Malignancies

Stephanie Lok Hang Cheung et al. Gut Liver. .

Abstract

The aim of this article is to review the different treatment options for malignant gastric outlet obstruction (GOO) and compare their safety and efficacy. We describe the history and evolution of gastrojejunostomy (GJ), endoscopic stenting and endoscopic ultrasonography-guided gastroenterostomy (EUS-GE) and analyze the current evidence regarding these three methods available in the literature, comparing their applicability, safety, complications and cost when used for the treatment of malignant GOO. We conclude that given the benefits of endoscopic techniques and the ability to place a stent away from the tumor, EUS-GE is a promising technique that may yield an efficacy similar to that of surgical GJ and duodenal stenting, with lower reintervention rates and fewer adverse events.

Keywords: Gastric outlet obstruction; Gastroenterostomy; Palliative care; Stents; Stomach neoplasm.

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Conflict of interest statement

CONFLICTS OF INTEREST

A.Y.B.T. is a consultant for Boston Scientific, Cook, Taewoong and Microtech Medical Corporations. No other potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Laparoscopic gastrojejunostomy.
Fig. 2
Fig. 2
Duodenal stenting with a partially covered duodenal stent.
Fig. 3
Fig. 3
(A) Direct method. (B) Balloon assisted method. (C) Endoscopic ultrasonography-guided balloon-occluded gastrojejunostomy bypass method. (D) The rendezvous method. (E) The retrograde method. LAMS, lumen-apposing selfexpandable metal stent.
Fig. 4
Fig. 4
Endoscopic ultrasonography-guided balloon-occluded gastrojejunostomy bypass. (A) Insertion of the short-type balloon overtube into the stomach. (B) Insertion of the double balloon-occlusion catheter and inflation of the balloons. (C) Deployment of the distal flange of the lumen-apposing self-expandable metal stent (LAMS). (D) Deployment of the proximal flange of the LAMS.
See this image and copyright information in PMC

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