eMedicine Specialties > General Surgery > Abdomen

Gastric Outlet Obstruction: Follow-up

Author: Andres E Castellanos, MD, Assistant Professor, Associate Surgical Residency Program Director, Department of Surgery, Drexel University College of Medicine
Coauthor(s): Elisa A Stein, MD, Staff Physician, Department of Surgery, Drexel University College of Medicine, Hahnemann University Hospital; Barry D Mann, MD, Program Director, Associate Professor, Department of Surgery, Division of General Surgery, MCP Hahnemann University; Erica Rachel Podolsky, MD, Resident Physician, Division of General Surgery, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Oct 29, 2009

Outcome and Prognosis

Gastric outlet obstruction (GOO) is a clinical condition that may result from a number of underlying causes, both benign and malignant. Despite medical advances in the acid suppression mechanism, the incidence of GOO remains a prevalent clinical problem in benign PUD. Also, an increase in the number of cases of GOO seems to be noted secondary to malignancy; this is possibly due to improvements in cancer therapy, which allow patients to live long enough to develop this complication.

Orient initial management to identification of the primary underlying cause and to the correction of volume and electrolyte abnormalities. Barium swallow studies and upper endoscopy are the main tests used to help make the diagnosis. Tailor treatment to the specific cause.

Future and Controversies

The role of prophylactic gastrojejunostomy in cases of malignant gastric outlet obstruction (GOO) is a question that has not been answered. Some surgeons argue that prophylactic gastrojejunostomy may increase postoperative morbidity, primarily due to delayed gastric emptying.

Lillemoe and Cameron addressed this issue in a publication.29 Of patients with unresectable periampullary cancer, 87 were randomized to receive or not receive a prophylactic gastrojejunostomy. Although results demonstrated that no significant differences exist in morbidity, length of hospital stay, and survival rates, the group in which prophylactic gastrojejunostomies were performed had a 0% (0/44) incidence of GOO versus 19% (8/43) in the other group. The authors concluded that prophylactic gastrojejunostomy significantly decreased the incidence of late GOO and should be performed routinely when a patient is undergoing surgical palliation for periampullary cancer. Comparable data are supported by other series.

 


More on Gastric Outlet Obstruction

Overview: Gastric Outlet Obstruction
Workup: Gastric Outlet Obstruction
Treatment: Gastric Outlet Obstruction
Follow-up: Gastric Outlet Obstruction
Multimedia: Gastric Outlet Obstruction
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Andersson A, Bergdahl L. Carcinoid tumors of the appendix in children. A report of 25 cases. Acta Chir Scand. 1977;143(3):173-5. [Medline].

  2. Gibson JB, Behrman SW, Fabian TC, Britt LG. Gastric outlet obstruction resulting from peptic ulcer disease requiring surgical intervention is infrequently associated with Helicobacter pylori infection. J Am Coll Surg. Jul 2000;191(1):32-7. [Medline].

  3. Lam YH, Lau JY, Fung TM, et al. Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection. Gastrointest Endosc. Aug 2004;60(2):229-33. [Medline].

  4. Taskin V, Gurer I, Ozyilkan E, Sare M, Hilmioglu F. Effect of Helicobacter pylori eradication on peptic ulcer disease complicated with outlet obstruction. Helicobacter. Mar 2000;5(1):38-40. [Medline].

  5. Gouma DJ, van Geenen R, van Gulik T, de Wit LT, Obertop H. Surgical palliative treatment in bilio-pancreatic malignancy. Ann Oncol. 1999;10 Suppl 4:269-72. [Medline].

  6. Doberneck RC, Berndt GA. Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg. Jul 1987;122(7):827-9. [Medline].

  7. Abdel-Salam WN, Katri KM, Bessa SS, et al. Laparoscopic-assisted truncal vagotomy and gastro-jejunostomy: trial of simplification. J Laparoendosc Adv Surg Tech A. Apr 2009;19(2):125-7. [Medline].

  8. Siu WT, Tang CN, Law BK, Chau CH, Yau KK, Yang GP, et al. Vagotomy and gastrojejunostomy for benign gastric outlet obstruction. J Laparoendosc Adv Surg Tech A. Oct 2004;14(5):266-9. [Medline].

  9. Kim SM, Song J, Oh SJ, et al. Comparison of laparoscopic truncal vagotomy with gastrojejunostomy and open surgery in peptic pyloric stenosis. Surg Endosc. Jun 2009;23(6):1326-30. [Medline].

  10. Hall NJ, Pacilli M, Eaton S, et al. Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet. Jan 31 2009;373(9661):390-8. [Medline].

  11. Jaffin BW, Kaye MD. The prognosis of gastric outlet obstruction. Ann Surg. Feb 1985;201(2):176-9. [Medline].

  12. Khullar SK, DiSario JA. Gastric outlet obstruction. Gastrointest Endosc Clin N Am. Jul 1996;6(3):585-603. [Medline].

  13. Kurtz RC, Sherlock P. Carcinoma of the stomach. In: Bockus Gastroenterology. 4th ed. Philadelphia, Pa: WB Saunders Co; 1985.

  14. Lillemoe KD, Sauter PK, Pitt HA, Yeo CJ, Cameron JL. Current status of surgical palliation of periampullary carcinoma. Surg Gynecol Obstet. Jan 1993;176(1):1-10. [Medline].

  15. Lillemoe KD, Cameron JL, Hardacre JM, Sohn TA, Sauter PK, Coleman J, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial. Ann Surg. Sep 1999;230(3):322-8; discussion 328-30. [Medline].

  16. Arciero CA, Joseph N, Watson JC, Hoffman JP. Partial stomach-partitioning gastrojejunostomy for malignant duodenal obstruction. Am J Surg. Mar 2006;191(3):428-32. [Medline].

  17. Bergamaschi R, Marvik R, Thoresen JE, Ystgaard B, Johnsen G, Myrvold HE. Open versus laparoscopic gastrojejunostomy for palliation in advanced pancreatic cancer. Surg Laparosc Endosc. Apr 1998;8(2):92-6. [Medline].

  18. Alam TA, Baines M, Parker MC. The management of gastric outlet obstruction secondary to inoperable cancer. Surg Endosc. Feb 2003;17(2):320-3. [Medline].

  19. Kantsevoy SV, Jagannath SB, Niiyama H, Chung SS, Cotton PB, Gostout CJ, et al. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc. Aug 2005;62(2):287-92. [Medline].

  20. Chopita N, Vaillaverde A, Cope C, et al. Endoscopic gastroenteric anastomosis using magnets. Endoscopy. Apr 2005;37(4):313-7. [Medline].

  21. Adler DG, Merwat SN. Endoscopic approaches for palliation of luminal gastrointestinal obstruction. Gastroenterol Clin North Am. Mar 2006;35(1):65-82, viii. [Medline].

  22. Baron TH. Surgical versus endoscopic palliation of malignant gastric outlet obstruction: big incision, little incision, or no incision?. Gastroenterology. Oct 2004;127(4):1268-9. [Medline].

  23. Telford JJ, Carr-Locke DL, Baron TH, Tringali A, Parsons WG, Gabbrielli A, et al. Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study. Gastrointest Endosc. Dec 2004;60(6):916-20. [Medline].

  24. Song GA, Kang DH, Kim TO, Heo J, Kim GH, Cho M, et al. Endoscopic stenting in patients with recurrent malignant obstruction after gastric surgery: uncovered versus simultaneously deployed uncovered and covered (double) self-expandable metal stents. Gastrointest Endosc. May 2007;65(6):782-7. [Medline].

  25. Yim HB, Jacobson BC, Saltzman JR, Johannes RS, Bounds BC, Lee JH, et al. Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc. Mar 2001;53(3):329-32. [Medline].

  26. Del Piano M, Ballare M, Montino F, Todesco A, Orsello M, Magnani C, et al. Endoscopy or surgery for malignant GI outlet obstruction?. Gastrointest Endosc. Mar 2005;61(3):421-6. [Medline].

  27. Wong YT, Brams DM, Munson L, Sanders L, Heiss F, Chase M, et al. Gastric outlet obstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. Surg Endosc. Feb 2002;16(2):310-2. [Medline].

  28. Huang YL, Lee HC, Yeung CY, et al. Sonogram before and after pyloromyotomy: the pyloric ratio in infantile hypertrophic pyloric stenosis. Pediatr Neonatol. Jun 2009;50(3):117-20. [Medline].

  29. Quigley RL, Pruitt SK, Pappas TN, Akwari O. Primary hypertrophic pyloric stenosis in the adult. Arch Surg. Sep 1990;125(9):1219-21. [Medline].

  30. Chopita N, Landoni N, Ross A, Villaverde A. Malignant gastroenteric obstruction: therapeutic options. Gastrointest Endosc Clin N Am. Jul 2007;17(3):533-44, vi-vii. [Medline].

  31. Holt AP, Patel M, Ahmed MM. Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?. Gastrointest Endosc. Dec 2004;60(6):1010-7. [Medline].

  32. Lillemoe KD, Cameron JL, Yeo CJ, Sohn TA, Nakeeb A, Sauter PK, et al. Pancreaticoduodenectomy. Does it have a role in the palliation of pancreatic cancer?. Ann Surg. Jun 1996;223(6):718-25; discussion 725-8. [Medline].

  33. Mauro MA, Koehler RE, Baron TH. Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents. Radiology. Jun 2000;215(3):659-69. [Medline].

  34. Schwarz A, Beger HG. Biliary and gastric bypass or stenting in nonresectable periampullary cancer: analysis on the basis of controlled trials. Int J Pancreatol. Feb 2000;27(1):51-8. [Medline].

  35. Shyr YM, Su CH, Wu CW, Lui WY. Prospective study of gastric outlet obstruction in unresectable periampullary adenocarcinoma. World J Surg. Jan 2000;24(1):60-4; discussion 64-5. [Medline].

  36. Wade TP, Neuberger TJ, Swope TJ, Virgo KS, Johnson FE. Pancreatic cancer palliation: using tumor stage to select appropriate operation. Am J Surg. Jan 1994;167(1):208-12; discussion 212-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

Clinical guidelines:
ACR Appropriateness Criteria® vomiting in infants up to 3 months of age. American College of Radiology - Medical Specialty Society. 1995 (revised 2008). 8 pages. NGC:007011

Evidence based clinical practice guideline hypertrophic pyloric stenosis. Cincinnati Children's Hospital Medical Center - Hospital/Medical Center. 2001 Aug 8 (revised 2007 Nov 4). 17 pages. NGC:006224

Surgical treatment of pancreatic cancer. Society for Surgery of the Alimentary Tract, Inc - Medical Specialty Society. 1996 (revised 2004 May 15). 3 pages. NGC:003753

Clinical trials:
Frequency of Formula Change Prior to the Accurate Diagnosis of Pyloric Stenosis

Magnetic Anastomosis Device Relief of Malignant Gastric Outlet Obstruction (MAD)

Open vs Laparoscopic Pyloromyotomy for Pyloric Stenosis

[ CLOSE WINDOW ]

Keywords

gastric outlet obstruction, pancreatic cancer, peptic ulcer, pyloric stenosis, gastric cancer, peptic ulcer disease, vagotomy, gastrojejunostomy, gastric outlet, pyloroplasty, periampullary cancer, antrectomy, gastric obstruction

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Andres E Castellanos, MD, Assistant Professor, Associate Surgical Residency Program Director, Department of Surgery, Drexel University College of Medicine
Andres E Castellanos, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Sanofi-adventis Consulting fee Consulting

Coauthor(s)

Elisa A Stein, MD, Staff Physician, Department of Surgery, Drexel University College of Medicine, Hahnemann University Hospital
Elisa A Stein, MD is a member of the following medical societies: American College of Physicians, American Medical Association, American Medical Student Association/Foundation, American Medical Women's Association, and Philadelphia County Medical Society
Disclosure: Nothing to disclose.

Barry D Mann, MD, Program Director, Associate Professor, Department of Surgery, Division of General Surgery, MCP Hahnemann University
Barry D Mann, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Education, American College of Surgeons, American Society of Bariatric Physicians, Association for Surgical Education, Society for Surgery of the Alimentary Tract, and Society of Surgical Oncology
Disclosure: Nothing to disclose.

Erica Rachel Podolsky, MD, Resident Physician, Division of General Surgery, Drexel University College of Medicine
Erica Rachel Podolsky, MD is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Michael A Grosso, MD, Consulting Staff, Department of Cardiothoracic Surgery, St Francis Hospital
Michael A Grosso, MD is a member of the following medical societies: American College of Surgeons, Society of Thoracic Surgeons, and Society of University Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Vice Chairman, Professor, Department of Surgery, Section of Gastrointestinal Medicine and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.