AGA Clinical Practice Update on the Optimal Management of the Malignant Alimentary Tract Obstruction: Expert Review

Abstract

BACKGROUND & AIMS:The purpose of this expert review is to describe the current methodologies available to manage malignant alimentary tract obstructions as well the evidence behind the various methods (including their efficacy and safety), indications, and appropriate timing of interventions. METHODS:This is not a formal systematic review but is based on a review of the literature to provide best practice advice statements. No formal rating of the quality of evidence or strength of recommendation is carried out.

Conservative management of malignant gastric outlet obstruction syndrome-evidence based evaluation of endoscopic ultrasound-guided gastroentero-anastomosis

“…EUS-GE has the advantage of being minimally invasive as an endoscopic procedure; weak evidence suggests that EUS-GE could provide long-lasting effects with lower recurrence rates[ 10 , 34 ]. Large high-quality evidence is still required in this field.…”

“…Finally, primary curative chemotherapy is usually indicated in patients with gastric lymphomas. However, in this subset of patients, gastrectomy may be indicated in advanced T stages due to the high risk of chemotherapy-induced gastric perforation[ 10 ].…”

“…Patients suffering from malignant GOO can be treated either with surgical gastro-jejunostomy (SGJ), endoscopic enteral self-expanding metal stent (SEMS) placement or EUS-GE[ 10 ].…”

Endoscopic ultrasound-guided jejunojejunal anastomosis as salvage therapy for a complex gastric outlet obstruction

“…Lumen-apposing metal stents are gaining ground in the treatment of gastric outlet obstruction (GOO) caused by malignant duodenal stenosis [1]. This technique is also opening up new alternatives as a rescue therapy for patients presenting with benign GOO and a previous history of gastric surgery or endoscopic procedures [2].…”

EUS-guided gastroenteric anastomosis

“…However, current data indicate that clinical outcomes of operative gastrojejunostomy and stent placement are comparable, though stenting appears to be associated with a shorter length of stay. [ 4 ]…”