Antroduodenal stenting for malignant gastric outlet obstruction: Technique and outcome

UdayC Ghoshal, Vinay Kumar
2019 Journal of Digestive Endoscopy  
Gastric outlet obstruction (GOO) is usually a late presentation of gastric cancer, pancreaticobiliary malignancy, and extrinsic lymph nodal compression. Presenting symptoms are abdominal pain, postprandial epigastric fullness, and recurrent vomiting, which lead to severe malnutrition and dehydration and poor quality of life (QoL). Endoscopic enteral stent placement has become the acceptable alternative modality for palliation of malignant GOO because it is safe, minimally invasive, and a
more » ... asive, and a cost-effective procedure. In addition, endoscopic stent placement leads to shorter time to resume oral diet and shorter hospital stay in comparison to surgical bypass. Endoscopic stent placement is associated with high technical as well as clinical success rates and improvement in QoL, but no survival improvement. Recurrence of symptoms occurs due to stent occlusion, or stent migration, which can be successfully managed with repeat endoscopic stent placement. Perforation and bleeding are serious but rare complications. GOO is usually a late complication of various pancreaticobiliary and gastroduodenal malignancies. Etiological spectrum of malignant GOO is variable depending on demography. One large multicenter study included 176 patients with malignant GOO. Pancreatic cancer (48%) was the most common cause of GOO, followed by metastases, gastric cancer, cholangiocarcinoma, papillary cancer, and gallbladder cancer. Duodenum was the most common site of obstruction. [10] Other studies also showed pancreatic cancer as the most common cause while gastric cancer was the most common etiology in some other studies. [11] [12] [13] [14] [15] Indian studies showed that cancers of the gallbladder, pancreas, and stomach were among the most common causes of
doi:10.4103/jde.jde_64_18 fatcat:tvupmnws3vgs3ivof3dwkx2jvy