Title: Fast Fact and Concept #91: Interventional options for upper GI obstructions
Author(s): James Ouellette, DO, ; Lisa Patterson, MD; Paula Termuhlen, MD
Patients with unresectable cancers of the upper gastrointestinal tract often suffer a very uncomfortable existence because of pain, nausea and vomiting, weight loss, cachexia and food fear. This can be related to gastric and duodenal cancers causing intrinsic obstruction of the intestinal lumen or pancreatic and biliary cancers causing extrinsic biliary compression. Management options vary depending on the site of obstruction, the patient functional status, the patient-defined goals for end of life care, and estimated prognosis. Fast Fact #45 discussed medical management options. This Fact Fact reviews interventional approaches, specifically for upper GI obstruction, especially when further curative surgery, external beam radiation, chemotherapy and medical management options may no longer be helpful. Listed below are treatment options for managing different sites of obstruction (listed from least invasive to most invasive). Management decisions for these problems are complex, requiring a multi-disciplinary approach (surgery, gastroenterology, radiology, palliative care) to achieve the best possible outcome with minimum morbidity.
Gastric or Duodenal obstruction
If unable to restore continuity of the gastrointestinal tract with a surgical procedure to bypass the obstruction, a combination of a gastrostomy tube with a separate jejunostomy tube can be used. This can provide enteral nutrition to the small intestine while venting the stomach. Patients can enjoy the pleasure of eating, even if the food is drained through the G-tube.
Adjuvant medications may augment the efficacy of these interventions.
References:Harris, G., Senagore, A. et. al. The management of neoplastic colorectal obstruction with colonic endoluminal stenting devices: Am J Surg 181:499-506, 2001.
Acunas, B., Poyanli, A., Rozanes, I. Intervention in gastrointestinal tract: the treatment of esophageal, gastroduodenal and colorectal obstructions with metallic stents. Eur J Rad 42:240-248, 2002.
Choi, Y. Laparoscopic gastrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc 16:1620-1626, 2002.
Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Ouellette J, Patterson L and Termuhlen P. Fast Facts and Concepts #91 INTERVENTIONAL OPTIONS FOR TREATING MALIGNANT UPPER GI OBSTRUCTION May 2003. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.
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Creation Date: 6/2003
Purpose: Instructional Aid, Self-Study Guide, Teaching
|Training: Fellows, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice|
|Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery|
ACGME Competencies: Medical Knowledge, Patient Care
Keyword(s): Antibiotics, Blood products, Cancer, Clinical interventions, Gastrointestinal, Hydration, Interventional procedures, Non-oral feeding, Radiation or chemotherapy, Rehabilitation, Surgery
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