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Published on: March 25, 2022
Palliative management of malignant gastric outlet obstruction: A practice review
Tanvi Acharya1,2, Anna Spathis1,2, Edmund Godfrey1
1Cambridge University Hospitals NHS Foundation Trust, UK.
Background:
Malignant gastric outlet obstruction is a frequent complication in advanced gastric, pancreatic and duodenal cancers, and can cause nausea, vomiting, pain, and malnutrition. No individual guideline comprehensively addresses the palliative management of malignant gastric-outlet-obstruction symptoms.
Aim:
To develop evidence-based recommendations for non-surgical palliative management of malignant gastric-outlet-obstruction, incorporating pharmacological, decompressive, endoscopic and nutritional strategies.
Design:
Practice review using scoping methodology to evaluate the strength of evidence supporting guideline-recommended interventions.
Data Sources:
We identified relevant national and international guidelines via web searches and the TRIP database; guideline reference lists were hand-searched for relevant primary studies; a supplementary structured MEDLINE search (2024) captured emerging research.
Results:
A multidisciplinary team approach, with early evaluation of prognosis and patient preference, should guide intervention choice. Pharmacological therapies (opioids, antiemetics, antisecretory agents) are frequently used for symptom control, but evidence of their efficacy in malignant gastric-outlet-obstruction is limited. Duodenal stenting remains first-line for endoscopic palliation, while endoscopic gastroenterostomy has emerging evidence supporting its effectiveness and should be considered. Nasogastric or venting gastrostomy decompression is advised for acute obstruction when endoscopy is not feasible, but prolonged NG tube use should be avoided. Early nutritional assessment is recommended, although the optimal modality and duration of nutritional supplementation have yet to be determined.
Conclusions:
Patient-centred, multidisciplinary care is essential for malignant gastric-outlet-obstruction palliation. Further research is needed to establish optimal drug combinations. Duodenal stenting remains first-line, but guidelines should incorporate newer minimally-invasive interventions such as endoscopic gastroenterostomy. Standardised quality-of-life measures are required for developing integrated care pathways.
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