Demographic and etiological patterns of gastric outlet obstruction in Kerala, South India

Abstract

Background:In the modern era, the major cause of gastric outlet obstruction (GOO) is known to be a malignancy, especially in the developed world. Many books and articles do suggest that the benign causes continue to be the major cause of GOO in the developing world however, there is growing evidence proving the contrary. Males were (more commonly) affected females and individuals in their fifth and sixth decade have been the predominant age group in the majority of studies. There is a minimal data of GOO from South India.Aims:A retrospective analysis of the endoscopic findings of patients presenting with features of GOO to determine the demographic and etiological patterns.Materials and Methods:A retrospective study of the endoscopic findings of patients with GOO from January 2005 to January 2014 was done. The diagnosis of GOO was based on clinical presentation, and an inability during the upper endoscopy to enter the second portion of the duodenum as documented in the endoscopy registers. Patients who have already been diagnosed with malignancy prior to the endoscopy were excluded from the study; so were the patients with gastroparesis.Results:A total of 342 patients with GOO underwent the endoscopy during the study period. The causes for benign obstruction were predominantly peptic ulcer disease. The major cause for malignant obstruction was carcinoma of stomach involving the distal stomach. The male to female ratio was 3.2:1. The patients with malignancy were older than patients with benign disorders. Most of the patients were in the sixth and seventh decade. The risk of malignancy was higher with increasing age, especially in women. A fourth of all carcinoma stomach presented with GOO.Conclusion:The study demonstrates that the cause for GOO in Kerala, South India is predominantly malignancy. The etiological and demographic patterns were similar to the studies conducted in the developed nations.

Palliation of malignant gastroduodenal obstruction with self‐expandable metal stent using side‐ and forward‐viewing endoscope: Feasibility and outcome

“…In this study, gallbladder carcinoma was the most common cause of malignant GOO. Etiology of malignant GOO in this study is in accordance with the other Indian studies, [22][23][24][25] although quite different from other parts of the world where pancreatic and gastric cancers are more common. 11,26,27 A longstanding gall stone is associated with higher incidence of gall bladder carcinoma, particularly in women living in the Gangetic plains of northern India.…”

A Short Term Outcome of Laparoscopic Hand Sewn and Stapled Gastrojejunostomy in Gastric Outlet Obstruction - An Observational Study

“…In our study Group A (Laparoscopic hand sewn anastomosis) comprised of 20 patients between the ages of 50 and 70 years (mean age: 59.6±6.29 years) while Group B (Laparoscopic stapled anastomosis) comprised of 20 patients in age range of 50 to 70 years (mean age: 60.9±6.77 years).Most of the patients were in age range of 50-59 years of age in both groups. Study done by Vivek, et al [12] showed the majority of the study population was between the age group of 40 and 80 years with a maximum number of individuals falling in the group of 51-60 years In study by Linda P. Zhang, et al [13] in a study a total of 28 patients were reviewed. Average age was 68 (range, 25 to 99).…”

Gastric outlet obstruction: A red flag, potentially manageable

“…The last several decades have seen a trend toward more cases due to cancer and fewer due to benign causes. [3][4][5][6][7][8][9][10][11][12][13][14] In earlier studies in both developed and developing countries, gastric adenocarcinoma was the most common malignant cause of gastric outlet obstruction. Since then, it has become less common in Western countries, although it remains more common in Asia and Africa.…”

“…Since then, it has become less common in Western countries, although it remains more common in Asia and Africa. [7][8][9][10][11][12][13][14] This trend likely refl ects environmental factors, including decreased prevalence of Helicobacter pylori infection, a major risk factor for gastric cancer, in Western countries. [15][16][17] At the same time, pancreatic cancer is on the rise, 16 and up to 20% of patients with pancreatic cancer develop gastric outlet obstruction.…”

“…2 Patients with gastric outlet obstruction secondary to malignancy generally present with a shorter duration of symptoms than those with peptic ulcer disease and are more likely to be older. 8,13 Other conditions with an acute onset of symptoms include gastric polyp prolapse, percutaneous endoscopic gastrostomy tube migration, gastric volvulus, and gallstone impaction.…”