Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature

Abstract

The major symptoms of advanced hepatopancreatic-biliary cancer are biliary obstruction, pain and gastric outlet obstruction (GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decision-making must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation of the patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

“…▶ EUS-GE, endoscopic ultrasound-guided gastroenterostomy 1 Other antibiotics prior to EUS-GE: β-lactam + metronidazole (n = 2), vancomycin (n = 1), ciprofloxacin (n = 1). 2 Other antibiotics after EUS-GE: β-lactam + metronidazole (n = 4), vancomycin (n = 1), ciprofloxacin (n = 1).…”

“…Malignant gastric outlet obstruction (GOO) can occur in up to 20 % of patients with advanced or metastatic malignancies located in the distal stomach and peri-pancreatic region [1]. Accompanying obstructive symptoms such as vomiting and nausea are a burden to patients and quickly lead to malnutrition and poor performance status [2].…”

Influence of peritoneal carcinomatosis on perioperative outcome in palliative gastric bypass for malignant gastric outlet obstruction - a retrospective cohort study

“…Another comparative therapy currently investigated is endoscopic ultrasound-guided GJJ (EUS-GJJ) which warrants further research [35]. From a pure surgical point of view, laparoscopic GJJ may provide an improvement over open GJJ but the currently available literature mainly consists of small case series or small case-control studies and 1 randomized trial comparing open and laparoscopic GJJ in only 24 patients [36,37]. Given the limited data and the complexity of malignant GOO, more clinical evidence is needed to evaluate the potential benefits of the laparoscopic approach over conventional open surgery [36].…”

Optimal Management of Gastric Outlet Obstruction in Unresectable Malignancies

“…Several studies have found that patients undergoing LGJ have a shorter median hospital stay with a difference of up to 10 days, shorter time to solid food intake (difference of 2 days), 4 lower intraoperative blood loss, 4 and reduced use of opiate analgesic. 5,6…”