Treatment of Malignant Gastric outlet Obstruction

Malignant gastric outlet obstruction (GOO)

is a very serious condition when a cancerous tumor or a mass is detected in the valve connecting the stomach to the duodenum which is the first part of the small intestine. Generally, the stomach empties its contents onto the duodenum through the valve. This valve is called the pylorus. In certain conditions, the lining of the pylorus gets thickened and cause the space in the valve to get constricted. It obstructs the food from passing through to the small intestine.This is also known as Pyloric Stenosis.
Cancerous obstruction of the pylorus is mostly seen in patients with stage IV metastatic cancers of the stomach, pancreas, duodenum, liver and stomach. In fact, 10 -25 % of pancreatic cancer patients face pyloric stenosis.


Symptoms of Gastric Outlet Obstruction

  • Nausea.
  • Vomiting.
  • Abdominal pain.
  • Belching.
  • Dehydration.
  • Cachexia, especially in cancer patients, which is wasting of the body structure by loss of muscle mass, body weight etc.
  • Overall decrease in the quality of life.

Treatment Methods of Malignant Gastric Outlet Obstruction

    Gastrojejunal anastomosis

    – It is a surgical by-pass procedure in which the obstruction is avoided by making separate connection of the stomach with the duodenum. In cancer patients, tumor can recur and cause obstruction even after removal and a second surgery in the same area is not advisable.
    Again, as much as 31% cancer patients are not symptom free even after the operation. This procedure also has a mortality rate of 2%.

    Duodenal Stenting

    – The next procedure specifically addresses all the flaws of the former. Using expandable endoprosthetic stents are safer and more effective in diminishing symptoms and improving the overall quality of life. In this procedure, a tiny metal stent or tube is placed to force open the duodenum or the beginning part of the small intestine. This is less invasive than surgery and provides immediate relief by allowing food and fluids to pass through to the small intestine and help complete the digestive cycle.

    Compared with gastric bypass surgery, patients developed less serious complications, and made a quicker recovery with a shorter stay in the Intensive Care Unit. The technical success rate of the procedure is 90-100%. The rate of serious complications in patients is 7% and non severe complications is 20%.

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