Management of gastric outlet obstruction: Focusing on endoscopic approach

Table 1 Causes of gastric outlet obstruction

Benign	Malignant
Peptic ulcer disease	Gastric cancer
Caustic ingestion	Gastric lymphoma
NSAID induced stricture	Pancreas cancer
Bouveret syndrome	Duodenal cancer
Hypertrophic pyloric stenosis	Cholangiocarcinoma
Iatrogenic	Gallbladder cancer
Post-surgical scar or anastomosis stricture	Metastatic cancer
Endoscopic submucosal dissection
Endoscopic mucosal resection
Inflammatory causes
Crohn’s disease
Pancreatitis
Inflammatory polyps
Infectious causes
Tuberculosis gastroenteritis
CMV gastroenteritis
Infiltrative causes
Eosinophilic gastroenteritis
Amyloidosis

NSAID: Nonsteroidal anti-inflammatory drugs; CMV: Cytomegalovirus.

Table 2 Treatment of gastric outlet obstruction based upon the underlying cause

Underlying cause	Treatment
Benign
Peptic ulcer disease	PPI ± HPE (1st option)	EBD or surgery (2nd option)
Crohn disease	Corticosteroid (1st option)	EBD or surgery (2nd option)
Caustic ingestion	EBD or surgery
Bouveret syndrome	Surgery or endoscopic removal
Large gastric polyp	Endoscopic resection
Malignant
Palliative	Endoscopic stent (covered or uncovered)
	EUS-guided gastroenterostomy
	Surgical resection, surgical bypass (gastrojejunostomy)
	Radiation therapy
Curative	Surgery
	Chemotherapy (for lymphoma)

PPI: Proton pump inhibitor; HPE: Helicobacter pylori eradication; EBD: Endoscopic balloon dilatation; EUS: Endoscopic ultrasound.