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Gastric outlet obstruction

S K Khullar¹, J A DiSario

¹Division of Gastroenterology, University of Utah School of Medicine and Health Sciences Center, Salt Lake City, USA.

Gastrointestinal Endoscopy Clinics of North America

|July 1, 1996

Summary

Malignant gastric outlet obstruction is best managed with endoscopic palliation, while peptic ulcer obstruction can be treated with endoscopic balloon dilation, often requiring repeat sessions and effective ulcer therapy for sustained relief.

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Area of Science:

Gastroenterology
Surgical Oncology

Background:

Acquired gastric outlet obstruction (AGOO) is frequently caused by malignancy or peptic ulcer disease.
Malignant AGOO often presents with poor surgical palliation outcomes, high morbidity, and mortality.
Endoscopic interventions are emerging as viable alternatives for managing AGOO.

Purpose of the Study:

To compare the efficacy and safety of endoscopic versus surgical palliation for malignant gastric outlet obstruction.
To evaluate endoscopic balloon dilation as a primary treatment for peptic ulcer-induced gastric outlet obstruction.
To assess the role of adjunctive therapies in improving outcomes for endoscopic treatments.

Main Methods:

Review of current literature on endoscopic and surgical management of AGOO.
Analysis of outcomes from initial experiences with expandable metallic endoprostheses for malignant AGOO.
Evaluation of endoscopic balloon dilation success rates and requirements for repeat procedures in peptic ulcer disease.
Assessment of the impact of acid reduction and H. pylori eradication on outcomes.

Main Results:

Endoscopic palliation with metallic endoprostheses shows promise for malignant AGOO, with initial experiences suggesting feasibility.
Endoscopic balloon dilation offers safe and effective treatment for peptic ulcer-induced AGOO, achieving sustained symptom relief in approximately 65% of patients.
Many patients undergoing balloon dilation require multiple sessions, and outcomes are improved with concurrent effective ulcer therapy.

Conclusions:

Endoscopic palliation is a promising alternative to surgery for malignant gastric outlet obstruction, potentially reducing morbidity and mortality.
Endoscopic balloon dilation is a safe and effective primary treatment for peptic ulcer-induced gastric outlet obstruction.
Optimizing ulcer management, including acid suppression and H. pylori eradication, is crucial for improving long-term outcomes of endoscopic interventions for AGOO.

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