Malignant gastric outlet obstruction: Which is the best therapeutic option?

Figure 1 Computed tomography scan appearance of malignant duodenal stricture with gastric distension due to pancreatic cancer.

Figure 2 Graphic representation of the main approaches applied to manage malignant gastric outlet obstruction. A: Surgical gastrojejunostomy; B: Endoscopic enteral stenting with self-expanding metal stents; C: Endoscopic ultrasound-guided gastroenterostomy.

Figure 3 Final endoscopic appearance of a duodenal uncovered self-expanding metal stent deployed across duodenal stricture, in a patient with gastric outlet obstruction due to pancreatic cancer.

Figure 4 Intra-operative image of laparoscopic gastrojejunostomy.

Figure 5 Endoscopic ultrasound view of the distended jejunal loop.

Figure 6 Endoscopic ultrasound-guided gastroenterostomy with the double balloon occluder. A: The double balloon occluder in place distending the small bowel in between; B: Endoscopic ultrasound-guided placement of lumen-apposing metal stent between the stomach and jejunum; C: Final endoscopic appearance of lumen-apposing metal stent.

Figure 7 Computed tomography scan appearance of endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stent placed between the stomach and jejunum.