From the Guidelines
The most common cause of gastric outlet obstruction is pancreas head cancer (option 2). Pancreatic adenocarcinoma of the head of the pancreas frequently causes gastric outlet obstruction due to its anatomical location adjacent to the duodenum and pylorus. As the tumor grows, it can directly invade or extrinsically compress the gastric outlet, leading to obstruction. This typically presents with symptoms such as persistent vomiting (often containing undigested food), early satiety, epigastric pain, and weight loss. Gastric outlet obstruction may be a late manifestation of pancreatic cancer, occurring after other symptoms like jaundice have already developed. While annular pancreas can cause congenital gastric outlet obstruction (typically presenting in infancy), and metastasis from colon cancer can occasionally cause gastric outlet obstruction, pancreatic head cancer remains the most common malignant cause in adults, as supported by recent studies 1.
Key Points
- Pancreatic head cancer is the most common cause of malignant gastric outlet obstruction in adults.
- Symptoms of gastric outlet obstruction include persistent vomiting, early satiety, epigastric pain, and weight loss.
- Management typically involves palliative measures such as endoscopic stenting or surgical bypass procedures to restore gastric emptying, as recommended by recent guidelines 1.
- The primary goals of palliation for patients with malignant gastric obstruction are to reduce nausea and vomiting and, when possible, allow resumption of an oral diet.
Management Options
- Endoscopic placement of self-expandable metal stents is a safe and effective minimally invasive palliative treatment for patients with luminal obstruction due to advanced gastric cancer 1.
- Surgical bypass procedures, such as gastrojejunostomy, may be considered in select patients.
- Chemotherapy and radiation therapy may also be used to alleviate symptoms and improve quality of life.
From the Research
Gastric Outlet Obstruction Causes
The most common cause of gastric outlet obstruction can be determined by analyzing the provided studies.
- Pancreas head cancer is a common cause of gastric outlet obstruction, as seen in studies 2, 3, and 4.
- Other causes, such as annular pancreas, metastasis from colon cancer, and unresectable gastric cancer, are also mentioned in the studies, but pancreas head cancer is more frequently associated with gastric outlet obstruction.
- Study 2 specifically discusses gastric outlet obstruction secondary to pancreatic cancer, highlighting its grim prognosis and the need for effective palliation.
- Study 3 recommends early surgical intervention with gastrojejunostomy for asymptomatic gastric outlet obstruction in pancreatic cancer patients, which may facilitate earlier postoperative recovery.
- Study 4 discusses the palliative management of malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer, emphasizing the importance of effective drainage and symptom relief.
Comparison of Treatment Options
The provided studies also compare different treatment options for gastric outlet obstruction, including:
- Gastrojejunostomy (GJJ) and endoscopic stenting (ES) are compared in study 5, which finds that ES has better short-term outcomes, while GJJ is preferable in terms of lower stent-related complications and longer patency duration.
- Study 4 discusses the emerging role of endoscopic ultrasound (EUS)-guided techniques, including EUS-guided biliary drainage and EUS-guided gastroenterostomy, which may become the preferred first-line palliative treatment for unresectable pancreatic cancer.