Gastric Outlet Obstruction: Current Status and Future Directions

Abstract

Gastric outlet obstruction (GOO) is a relatively common condition in which mechanical obstruction of the pylorus, distal stomach, or duodenum causes severe symptoms such as nausea, vomiting, abdominal pain, and early satiety. Its etiology includes both benign and malignant disorders. Currently, GOO has many treatment options, including initial conservative therapeutic protocols and more invasive procedures, such as surgical gastroenterostomy, stent placement and, the most recently implemented procedure, endoscopic ultrasound-guided gastroenterostomy (EUS-GE). Each procedure has its merits, with surgery often prevailing in patients with longer life expectancy and stents being used most often in patients with malignant gastric outlet stenosis. The newly developed EUS-GE combines the immediate effect of stents and the long-term efficacy of gastroenterostomy. However, this novel method is a technically demanding process that requires expert experience and special facilities. Thus, the true clinical effectiveness, as well as the duration of the effects of EUS-GE, still need to be determined.

Keywords: Endoscopic ultrasound-guided gastroenterostomy; Gastric outlet obstruction; Gastric outlet stenosis; Gastroenterostomy; Self expandable metal stent.

Fig. 1

Placement of a self-expandable metal stent (SEMS) under endoscopic view. Note the placement of a guidewire over the obstruction (A), gradual deployment of the stent over the delivery system (B, C), as well as the SEMS in situ, gradually expanding to its full size (D).

Fig. 2

Placement of a self-expandable metal stent under fluoroscopic assistance. Note a biliary stent already placed, with the biliary tracts opacified (A), placement of the delivery system over the obstruction (B) and gradual opening of the stent (C, D), which was finally placed (E). Four days later the stent was finally expanded to its full size (F).