GuidelineThe role of endoscopy in gastroduodenal obstruction and gastroparesis
Section snippets
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.
References (97)
- et al.
American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis
Gastroenterology
(2004) - et al.
Paraneoplastic gastrointestinal motor dysfunction: clinical and laboratory characteristics
Am J Gastroenterol
(2001) - et al.
Small-bowel obstruction: state-of-the-art imaging and its role in clinical management
Clin Gastroenterol Hepatol
(2008) - et al.
Multidetector row computed tomography of small bowel obstruction
Semin Ultrasound CT MR
(2008) - et al.
American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis
Gastroenterology
(2004) - et al.
Abnormal postcibal antral and small bowel motility due to neuropathy or myopathy in systemic sclerosis
Gastroenterology
(1989) - et al.
Long-term follow-up in patients who have undergone balloon dilation for gastric outlet obstruction
Gastrointest Endosc
(1990) - et al.
The role of endoscopy in the management of patients with peptic ulcer disease
Gastrointest Endosc
(2010) - et al.
Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection
Gastrointest Endosc
(2004) - et al.
Endoscopic balloon dilation in caustic-induced chronic gastric outlet obstruction
Gastrointest Endosc
(2009)
Long-term follow-up of patients with gastric outlet obstruction related to peptic ulcer disease treated with endoscopic balloon dilatation and drug therapy
Gastrointest Endosc
Enteral stents
Gastrointest Endosc
Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients
Am J Gastroenterol
A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction
Am J Surg
Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients
Gastrointest Endosc
Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study
Gastrointest Endosc
Self-expandable metal stent placement for the palliation of malignant gastroduodenal obstruction: experience in a large, single, UK centre
Clin Radiol
Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): a prospective multicenter study
Gastrointest Endosc
Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study
Gastrointest Endosc
Bridging across the ampulla of Vater with covered self-expanding metallic stents: is it contraindicated when treating malignant gastroduodenal obstruction?
J Vasc Interv Radiol
Endoscopic fenestration of duodenal stents using argon plasma to facilitate ERCP
Gastrointest Endosc
Combined gastric drainage and jejunal feeding through a percutaneous endoscopic stoma
Gastrointest Endosc
Protocol for the treatment of malignant inoperable bowel obstruction: a prospective study of 80 cases at Grenoble University Hospital Center
J Pain Symptom Manage
Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma
Gynecol Oncol
Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: a comparison of indications, complications and outcomes in 370 patients
Eur J Radiol
Role of endoscopy in enteral feeding
Gastrointest Endosc
Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy
Clin Radiol
Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial
Gastrointest Endosc
An analysis of cost and clinical outcome in palliation for advanced pancreatic cancer
Am J Surg
Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction
Gastrointest Endosc
Serum glucose concentration as a modulator of interdigestive gastric motility
Gastroenterology
Percutaneous endoscopic gastrostomy for decompression of the stomach and small bowel
Gastrointest Endosc
Venting percutaneous gastrostomy in the treatment of refractory idiopathic gastroparesis
Gastrointest Endosc
Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease
Am J Surg
Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle
Am J Gastroenterol
Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis
Gastrointest Endosc
Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis
Gastrointest Endosc
Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis
Gastrointest Endosc
Gastric electrical stimulation for medically refractory gastroparesis
Gastroenterology
A systematic review of surgical therapy for gastroparesis
Am J Gastroenterol
High-resolution EUS to differentiate hypertrophic pyloric stenosis
Gastrointest Endosc
Recurrent pyloric stenosis: to dilate or operate?A preliminary report
J Pediatr Surg
Pneumatic dilation in treatment of late-onset primary gastric outlet obstruction in childhood
J Pediatr Surg
Resolution of symptomatic GERD and delayed gastric emptying after endoscopic ablation of antral diaphragm (web)
Gastrointest Endosc
Clinical management of motility disorders in children
Semin Pediatr Surg
Gastric outlet obstruction in children: an overview with report of Jodhpur disease and Sharma's classification
J Pediatr Surg
Outcomes of pyloroplasty and pyloric dilatation in children diagnosed with nonobstructive delayed gastric emptying
J Pediatr Surg
GRADE: an emerging consensus on rating quality of evidence and strength of recommendations
BMJ
Cited by (74)
System and approach to detecting of gastric slow wave and environmental noise suppression based on optically pumped magnetometer
2024, Biocybernetics and Biomedical EngineeringGastroparesis: an evidence-based review for the bariatric and foregut surgeon
2023, Surgery for Obesity and Related DiseasesUpper Gastrointestinal Functional and Motility Disorders in Children
2021, Pediatric Clinics of North AmericaCitation Excerpt :Although separating these diagnoses clinically is challenging, more severe abdominal symptoms were associated with true delayed gastric emptying in one pediatric cohort.73 The gold standard for diagnosis of GP remains solid-meal 4-hour nuclear gastric emptying scintigraphy (GES)74; EGD and contrast studies are useful to rule out mucosal diseases and a gastro-duodenal obstructive process.75 Consistently, greater than 10% retention of radiolabeled food contents at 4 hours outperformed normative cutoffs at earlier timepoints.
70-Year-Old Man With Chronic Nausea and Vomiting
2021, Mayo Clinic ProceedingsAssessment of the learning curve for EUS-guided gastroenterostomy for a single operator
2021, Gastrointestinal Endoscopy
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.