Malignant gastric outlet obstruction:Which is the best therapeutic option?
作者机构：Department of Systems MedicineUniversity of Rome“Tor Vergata”Rome 00133Italy Endoscopy UnitHumanitas Clinical and Research Center–IRCCS-via Manzoni 5620089 Rozzano(Mi)Italy Humanitas UniversityDepartment of Biomedical SciencesVia Rita Levi Montalcini 420090 Pieve EmanueleMilanItaly Department of SurgeryPrince of Wales HospitalChinese University of Hong KongHong Kong 999077China
出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)
年 卷 期：2020年第26卷第16期
页 面：1847-1860页
核心收录：
学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学]
主 题：Gastrojejunostomy Self-expanding metal stent Enteral stent Interventional endoscopic ultrasonography Endoscopic ultrasound-guided gastroenterostomy Pancreatic cancer Gastric cancer Duodenal stricture
摘 要：Malignant gastric outlet obstruction(MGOO)is a clinical condition characterized by the mechanical obstruction of the pylorus or the duodenum due to tumor compression/infiltration,with consequent reduction or impossibility of an adequate oral *** is mainly secondary to advanced pancreatic or gastric cancers,and significantly impacts on patients’survival and quality of *** suffering from this condition often present with intractable vomiting and severe malnutrition,which further compromise therapeutic ***,palliative strategies are based primarily on surgical gastrojejunostomy and endoscopic enteral stenting with self-expanding metal *** studies have shown that surgical approach has the advantage of a more durable relief of symptoms and the need of fewer re-interventions,at the cost of higher procedure-related risks and longer hospital *** the other hand,enteral stenting provides rapid clinical improvement,but have the limit of higher stent dysfunction rate due to tumor ingrowth and a subsequent need of frequent ***,a third way has come from interventional endoscopic ultrasound,through the development of endoscopic ultrasound-guided gastroenterostomy technique with lumen-apposing metal *** new technique may ideally encompass the minimal invasiveness of an endoscopic procedure and the long-lasting effect of the surgical gastrojejunostomy,and brought encouraging results so far,even if prospective comparative trial are still *** this Review,we described technical aspects and clinical outcomes of the above-cited therapeutic approaches,and discussed the open questions about the current management of MGOO.
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