Jiang L, Chen XP. Treatment of choice for malignant gastric outlet obstruction: More than clearing the road. World J Gastrointest Endosc 2024; 16(11): 587-594 [PMID: 39600555 DOI: 10.4253/wjge.v16.i11.587]
Corresponding Author of This Article
Xiao-Ping Chen, MD, PhD, Chief, Chief Doctor, Dean, Director, Professor, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. chenxpchenxp@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
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/
World J Gastrointest Endosc. Nov 16, 2024; 16(11): 587-594 Published online Nov 16, 2024. doi: 10.4253/wjge.v16.i11.587
Treatment of choice for malignant gastric outlet obstruction: More than clearing the road
Li Jiang, Xiao-Ping Chen
Li Jiang, Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Xiao-Ping Chen, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Author contributions: Chen XP designed the study, reviewed and edited the manuscript; Jiang L performed the research and wrote the original draft.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Ping Chen, MD, PhD, Chief, Chief Doctor, Dean, Director, Professor, Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan 430000, Hubei Province, China. chenxpchenxp@163.com
Received: August 10, 2024 Revised: October 2, 2024 Accepted: October 20, 2024 Published online: November 16, 2024 Processing time: 80 Days and 11.5 Hours
Abstract
In this editorial, we comment on the in-press article in the World Journal of Gastrointestinal Endoscopy concerning the treatment of malignant gastric outlet obstruction (mGOO). The original theory of treatment involves bypassing the obstruction or reenabling the patency of the passage. Conventional surgical gastroenterostomy provides long-term relief of symptoms in selected patients, with substantial morbidity and a considerable rate of delayed gastric emptying. Endoscopic stenting was introduced as an alternative minimally invasive procedure with less procedural morbidity and rapid clinical improvement; however, it presented a high rate of long-term recurrence. Therefore, challenges remain in the treatment of mGOO patients to improve clinical outcomes. Endoscopic ultrasound-guided gastroenterostomy has recently emerged as a promising method because of the combined effects of surgery and endoscopy, whereas stomach-partitioning gastrojejunostomy has been reported as a modified surgical procedure to reduce the rate of delayed gastric emptying. In decision-making regarding the treatment of choice, it should be taken into account that mGOO might be accompanied by a variety of pathological conditions, including cancer cachexia, anorexia, malabsorption, and etc., all of which can also lead to the characteristic symptoms and poor nutritional status of mGOO. The treatment plan should consider comprehensive aspects of patients to achieve practical improvements in prognosis and the quality of life.
Core Tip: The original idea for malignant gastric outlet obstruction (mGOO) treatment involves bypassing the obstruction via surgical gastroenterostomy or reopening the passage via endoscopic stenting. Substantial morbidity and only partial relief from conventional procedures have prompted modified procedures, such as endoscopic ultrasound-guided gastroenterostomy and stomach-partitioning gastrojejunostomy, for which there is limited evidence for synthesis. Notably, mGOO is usually accompanied by a variety of pathological conditions that can result in presentations similar to or the same as those of mGOO. A multidisciplinary approach should be adopted for decision-making in treatment plans.
