Malignant gastroparesis and outlet obstruction in carcinoma gall bladder

Malignant gastroparesis and mechanical gastric outlet obstruction are two major accompaniments of advanced upper abdominal malignancies. The incidence of such problems has not been well documented in patients of carcinoma gall bladder. The aim of this study was to determine the incidence of gastric outlet problems in patients of carcinoma gall bladder and correlate them with clinical presentation. The role of prophylactic gastrojejunostomy (GJ) and its postoperative outcome was also evaluated.

Thirty seven patients of carcinoma gall bladder were prospectively studied. Twenty five patients underwent radio labelled solid meal gastric emptying study and eleven of these underwent prophylactic GJ and followup gastric emptying study in early postoperative period.

Mechanical gastric outlet obstruction was seen in 10 (27%) patients. Delayed gastric emptying on scintigraphic study was found in 10 (40%) of remaining patients (n = 25). Only 6 (60%) of these patients were actually symptomatic. All patients who had delayed gastric emptying also had an advanced disease. No correlation was found between delayed gastric emptying and presence of jaundice and/or serum levels of bilirubin. Prophylactic GJ had 18% postoperative morbidity as compared to 28.5% for therapeutic GJ done during the same period. Oral feed were started latest by 11th postoperative day. Prophylactic GJ did not affect gastric emptying patterns in early postoperative period.

Mechanical gastric outlet obstruction was present in 27% patients. Delayed gastric emptying was seen in 40% of remaining patients with carcinoma gall bladder. Delayed gastric emptying correlated well with symptoms of gastric stasis and the stage of disease. Functioning of gastrojejunostomy was not fully dependent on presence or absence of malignant gastroparesis.