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World J Gastrointest Surg. Aug 27, 2016; 8(8): 545-555
Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.545
Surgical palliation of gastric outlet obstruction in advanced malignancy
Brittany A Potz, Thomas J Miner
Brittany A Potz, Thomas J Miner, Department of Surgical Oncology, Warren Alpert Medical School Brown University, Providence, RI 02906, United States
Author contributions: Potz BA and Miner TJ worked on the concept, design, manuscript writing and manuscript review.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Thomas J Miner, MD, Department of Surgical Oncology, Warren Alpert Medical School Brown University, 2 Dudley Street, Providence, RI 02906, United States. tminer@usasurg.org
Telephone: +1-401-4210245 Fax: +1-401-8682310
Received: March 26, 2016
Peer-review started: March 26, 2016
First decision: April 19, 2016
Revised: April 30, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: August 27, 2016
Processing time: 153 Days and 8.2 Hours
Abstract

Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. The performance status and medical condition of the patient, the extent of the cancer, the patients prognosis, the availability of a curative procedure, the natural history of symptoms of the disease (primary and secondary), the durability of the procedure, and the quality of life and life expectancy of the patient should always be considered when choosing treatment for any patient with advanced malignancy. Gastrojejunostomy appears to be associated with better long term symptom relief while stenting appears to be associated with lower immediate procedure related morbidity.

Keywords: Surgical palliation; Gastric outlet obstruction; Advanced malignancy; Gastrojejunostomy; Endoscopic stenting

Core tip: Gastric outlet obstruction (GOO) is a common problem associated with advanced malignancies of the upper gastrointestinal tract. Palliative treatment of patients’ symptoms who present with GOO is an important aspect of their care. Surgical palliation of malignancy is defined as a procedure performed with the intention of relieving symptoms caused by an advanced malignancy or improving quality of life. Palliative treatment for GOO includes operative (open and laparoscopic gastrojejunostomy) and non-operative (endoscopic stenting) options. Regardless of the treatment used for relief of symptoms all physicians having end of life conversations with patients should be adequately trained in end of life care to ensure that patients are getting the optimal treatment for their particular circumstances.