Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Sep 15, 2021; 13(9): 1086-1098
Published online Sep 15, 2021. doi: 10.4251/wjgo.v13.i9.1086
Conservative management of malignant gastric outlet obstruction syndrome-evidence based evaluation of endoscopic ultrasound-guided gastroentero-anastomosis
Anna Cominardi, Giacomo Tamanini, Nicole Brighi, Pietro Fusaroli, Andrea Lisotti
Anna Cominardi, Giacomo Tamanini, Andrea Lisotti, Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Imola 40026, BO, Italy
Nicole Brighi, Department of Medical Oncology, Istituto Scientifico Romagnolo Per Lo Studio Dei Tumori “Dino Amadori” (IRST) IRCCS, Meldola 47014, FC, Italy
Pietro Fusaroli, Department of Medical and Surgical Sciences, University of Bologna/Hospital of Imola, Bologna 40121, Italy
Author contributions: Cominardi A and Lisotti A wrote the paper; Cominardi A and Tamanini G performed data collection and a systematic review of the literature; Brighi N and Fusaroli P reviewed the manuscript for pivotal intellectual contents.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
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:
Corresponding author: Anna Cominardi, MD, Research Fellow, Senior Postdoctoral Fellow, Department of Gastroenterology Unit, Hospital of Imola, University of Bologna, Via Montericco 4, Imola 40026, BO, Italy.
Received: February 21, 2021
Peer-review started: February 21, 2021
First decision: April 6, 2021
Revised: April 16, 2021
Accepted: July 21, 2021
Article in press: July 21, 2021
Published online: September 15, 2021

Gastric outlet obstruction (GOO) is a clinical syndrome characterized by postprandial vomiting, abdominal pain, bloating and, in advanced cases, by weight loss secondary to inadequate oral intake. This clinical entity may be caused by mechanical obstruction, either benign or malignant, or by motility disorders. In this review we will focus on malignant GOO and on its endoscopic ultrasound (EUS)-guided palliative treatment. The most frequent malignant causes of this syndrome are gastric and locally advanced pancreatic carcinomas; other causes include duodenal or ampullary neoplasms, gastric lymphomas, retroperitoneal lymphadenopathies and, more infrequently, gallbladder and bile duct cancers. Surgery represents the treatment of choice when radical and curative resection is potentially feasible; if the malignant cause is not likely to be completely resected, palliative treatments should be proposed. Palliative treatments for malignant GOO are primarily based on surgical gastro-jejunostomy and endoscopic placement of an enteral self-expanding metal stent. Both treatments are effective; however, endoscopic stent placement is less invasive and it is associated with good short-term results, while surgery provides longer-lasting effects with a lower frequency of reintervention. In the last few years, EUS-guided gastroenterostomy (GE) has been proposed as palliative treatment for malignant GOO. This novel technique consists of the creation of an anastomosis between the gastric lumen and a small bowel loop distal to the malignant obstruction, through the deployment of a lumen-apposing metal stent under EUS-view. EUS-GE has the advantage of being as minimally invasive as enteral stent placement, and of guaranteeing long-term results similar to those of surgery.

Keywords: Gastric outlet obstruction, Endoscopic ultrasound-guided gastroenterostomy, Endoscopic ultrasound, Enteric anastomosis, Lumen-apposing metal stents

Core Tip: Malignant gastric outlet obstruction is a clinical syndrome affecting patients with advanced pancreatic adenocarcinoma, gastric and duodenal cancer, or retroperitoneal neoplasms. Recently, endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing metal stent has been proposed as a minimally invasive and long-lasting endoscopic palliative treatment for this condition. This technique has not only shown similar technical and clinical success rates to those of surgical gastro-jejunostomy and endoscopic enteral stent placement, but it also results in a lower rate of reintervention, adverse events, and costs.