scholarly journals Malignant Gastric Outlet Obstruction from Pancreatic Cancer

2017 ◽  
Vol 11 (3) ◽  
pp. 511-515 ◽  
Author(s):  
Clare McGrath ◽  
Adrian Tsang ◽  
Harrish  Nithianandan ◽  
Eric Nguyen ◽  
Patrick Bauer ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Gastric Outlet Obstruction ◽  
Gastrointestinal Symptoms ◽  
Outlet Obstruction ◽  
Exceptional Case ◽  
Uncinate Process ◽  
Malignant Gastric Outlet Obstruction ◽  
Life Threatening ◽  
Upper Gastrointestinal Symptoms

Patients with advanced-stage pancreatic cancer are typically burdened by many symptoms that impair functioning and worsen quality of life. We report an exceptional case of a 73-year-old woman with T4N1M0 adenocarcinoma of the uncinate process of the pancreas who developed significant gastric outlet obstruction – an uncommon yet potentially life-threatening complication of disease progression. She developed progressive abdominal pain and emesis, and profound dilatation of her stomach was detected on a radiation therapy simulation CT scan that required urgent decompression. Malignant gastric outlet obstruction must be included in the differential diagnosis when patients with known advanced disease of the pancreas present with obstructive upper gastrointestinal symptoms.

scholarly journals Diabetic Gastroparesis

2019 ◽  
Vol 40 (5) ◽  
pp. 1318-1352 ◽  
Author(s):  
Adil E Bharucha ◽  
Yogish C Kudva ◽  
David O Prichard
Keyword(s):  
Glycemic Control ◽  
Gastrointestinal Symptoms ◽  
Outlet Obstruction ◽  
Diabetic Gastroparesis ◽  
Oral Nutrition ◽  
Ghrelin Receptor ◽  
Receptor Agonists ◽  
Wireless Motility Capsule ◽  
Upper Gastrointestinal Symptoms

AbstractThis review covers the epidemiology, pathophysiology, clinical features, diagnosis, and management of diabetic gastroparesis, and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus. Up to 50% of patients with type 1 and type 2 DM and suboptimal glycemic control have delayed gastric emptying (GE), which can be documented with scintigraphy, 13C breath tests, or a wireless motility capsule; the remainder have normal or rapid GE. Many patients with delayed GE are asymptomatic; others have dyspepsia (i.e., mild to moderate indigestion, with or without a mild delay in GE) or gastroparesis, which is a syndrome characterized by moderate to severe upper gastrointestinal symptoms and delayed GE that suggest, but are not accompanied by, gastric outlet obstruction. Gastroparesis can markedly impair quality of life, and up to 50% of patients have significant anxiety and/or depression. Often the distinction between dyspepsia and gastroparesis is based on clinical judgement rather than established criteria. Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed GE. Alternatively, there are limited data to suggest that delayed GE may affect glycemic control. The management of diabetic gastroparesis is guided by the severity of symptoms, the magnitude of delayed GE, and the nutritional status. Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation. Promising newer therapeutic approaches include ghrelin receptor agonists and selective 5-hydroxytryptamine receptor agonists.

A prospective multicenter observational study of surgical palliation examining postoperative quality of life in patients treated for malignant gastric outlet obstruction caused by incurable advanced gastric cancer.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 6-6 ◽  
Author(s):  
Kazumasa Fujitani ◽  
Masahiko Ando ◽  
Kentaro Sakamaki ◽  
Masanori Terashima ◽  
Ryohei Kawabata ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Oral Intake ◽  
Malignant Gastric Outlet Obstruction ◽  
Surgical Palliation ◽  
The Mean

6 Background: Decision-making for surgical palliation remains one of the most challenging clinical scenarios since quality of life (QOL) is a key component of cancer care. We conducted this study to examine the impacts of surgical palliation on postoperative QOL in patients (pts) with malignant gastric outlet obstruction (GOO) caused by incurable primary gastric cancer (GC). Methods: Eligibility included (1) no oral intake or liquids only requiring parenteral nutrition (2) aged ≥20 (3) surgically fit (4) ECOG PS of 0-2 and (5) written IC. Patients underwent either palliative distal/total gastrectomy (DG/TG) or gastrojejunostomy (GJS). Treatment choice was left to the discretion of the physician. Validated QOL instruments (EORTC QLQ-STO22 and EuroQol-5D) assessed QOL at baseline, 2 weeks (wks), 1 month (m), and 3 months following the surgical palliation, and two observational outcomes (postoperative improvement of oral intake, and safety of surgical intervention) were evaluated. Results: 104 pts, 71 males and 33 females with a median age of 68 years, were enrolled. The types of surgery were DG in 23 pts, TG in 9 pts, GJS in 70 in pts, and exploratory laparotomy in 2 pts. Baseline QOL questionnaires were completed by 103 (99.0%) pts. Among the 104 pts, 98 (94.2%), 100 (96.1%), and 81 (77.9%) completed the 2-wk, 1-m, and 3-m follow-up survey, respectively. The mean baseline EQ-5D score was 0.74 (SD, 0.21). During the follow-up period, the mean scores remained consistent with the baseline scores; the change from baseline score was within ± 0.05 for the index. Many pts came to eat solid food at 2 wks postsurgery and remained tolerable thereafter (from 0 at baseline to 82, 85, 75 pts at 2 wks, 1 m, and 3 ms, respectively). Overall morbidity rate of ≥grade 3 on Clavien-Dindo classification and 30-day postoperative mortality rate was 9.6% (10 pts) and 2.0% (2 pts) with a median hospital stay of 13 days and re-operation rate of 3.9% (4 pts). Conclusions: In pts with malignant GOO caused by advanced GC, surgical palliation maintained patient QOL while improving solid food intake with an acceptable surgical safety. Clinical trial information: UMIN000023494.

Palliation for Malignant Gastric Outlet Obstruction: A Prospective Quality of Life Study

2008 ◽  
Vol 67 (5) ◽  
pp. AB251
Author(s):  
Carl R. Schmidt ◽  
Hans Gerdes ◽  
William G. Hawkins ◽  
Erica Zucker ◽  
Qin Zhou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Gastric Outlet Obstruction ◽  
Outlet Obstruction ◽  
Life Study ◽  
Malignant Gastric Outlet Obstruction

scholarly journals Palliative Treatment of Unresectable Pancreatic Carcinoma Presenting as Gastric Outlet Obstruction: What to Expect?

2021 ◽  
Vol 33 (2) ◽  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Carcinoma ◽  
Gastric Outlet Obstruction ◽  
Recent Literature ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
First Case ◽  
Health Practitioners ◽  
Life Threatening ◽  
Severe Epigastric Pain

Gastric outlet obstruction is a surgical emergency that presents with epigastric pain and intractable non-bilious vomiting. As per a recent literature review, theleading cause of gastric outlet obstruction is malignancy. This report presents a patient with grade two pancreatic adenocarcinoma who presented with gastric outlet obstruction symptoms: apotentially life-threatening complication of disease progression.The patient experienced severe epigastric pain and intractable projectile non-bilious vomiting.Computed Tomography confirmed the cause of severe pain and vomiting as gastric outlet obstruction. The patient was successfully managed with laparoscopic palliative gastro-jejunostomy and jejuno-jejunostomy. Here is the first case reported in the kingdom of Bahrain, where a patient with pancreatic cancer presented with symptoms of gastric outlet obstruction.The case report aimed to increaseawareness amongst health practitioners regarding the presentation of pancreatic cancer. Keywords: Adenocarcinoma; Gastric Outlet Obstruction; Jejunostomy; Laparoscopy; Pancreatic Carcinoma

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