Guideline
The role of endoscopy in gastroduodenal obstruction and gastroparesis

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Etiology and presentation

Gastric outlet obstruction (GOO) is caused by mechanical gastroduodenal obstruction or motility disorders and can be divided into 3 major categories: benign mechanical, malignant mechanical, and motility disorders (Table 2). Peptic ulcer disease with or without secondary stricture is the most common cause of benign mechanical GOO, although the recent decline in peptic ulcer disease has decreased the incidence of clinically evident peptic strictures.2 Malignant mechanical GOO usually results

Evaluation

Most patients with signs or symptoms of gastroduodenal obstruction or dysmotility will require structural evaluation with EGD and/or radiographic studies. If complete intestinal obstruction or perforation is suspected, initial evaluation with radiographic studies should be performed before endoscopy. CT is the preferred radiologic test for suspected intestinal obstruction.12, 13, 14 Because oral barium contrast may interfere with subsequent endoscopy, its use should be minimized or avoided if

Benign mechanical obstruction

Treatment options for benign mechanical obstruction include balloon dilation, self-expandable metal stent (SEMS) placement, and surgery. GOO related to peptic ulcer disease can be treated with balloon dilation.23, 24, 25, 26 Although technical success with immediate symptom improvement is common, multiple dilations are often required.23 Perforation rates with balloon dilation in benign peptic strictures range from 3% to 7%, with higher rates corresponding to larger balloon diameter of more than

Special considerations for the pediatric population

GOO in early infancy often results from congenital defects of the upper GI tract (Table 2). Hypertrophic pyloric stenosis, the most common cause of GOO in children, typically presents in early infancy. Diagnosis is directed by the clinical picture and radiologic evaluation. Clinical features include those typical of upper intestinal obstruction (eg, vomiting), although a history of polyhydramnios during pregnancy may signify the presence of in utero obstruction before delivery. Plain abdominal

Disclosure

Dr Harrison served as a consultant for Fujinon, Inc. Dr Decker served as a consultant for Facet Biotechnology. Dr Fanelli received honoraria from Ethicon, served as a consultant for RII Biologics, and is the owner/governor of New Wave Surgical Corp. Dr Jain served as a researcher for BARRX Medical, Inc. No other financial relationships relevant to this publication were disclosed.

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    This document is a product of the ASGE Technology Assessment Committee. This document was reviewed and approved by the Governing Board of the American Society for Gastrointestinal Endoscopy.

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