Surgical and Endoscopic Options for Benign and Malignant Gastric Outlet Obstruction

Abstract

Gastric outlet obstruction (GOO) can be due to a variety of causes of both benign and malignant sources. As the etiology of GOO shifts from mostly benign to mostly malignant, treatment options have also evolved. Traditional options have only included surgery, but an increase in technology has seen the emergence of endo-scopic alternatives. For benign disease, such as peptic ulcer disease, endoscopic balloon dilation has reduced the number of patients needing to undergo larger and more invasive surgical procedures. It has also proven successful in treating obstruction from stricture following bariatric surgery, but surgical revision or reversal remains the gold standard. Numerous surgical procedures have shown effectiveness when treating GOO, with new procedures constantly emerging. When malignancy is the cause, the procedural focus shifts from curative to palliative with the main focus being resumption of oral intake. Endoscopic stenting provides a viable alternative to gastro-jejunos-tomy, but due to problems with re-obstruction and stent migration, it should be reserved for patients with shorter life expectancies.