• Edoardo Troncone, Alessandro Fugazza, Annalisa Cappello, Giovanna Del Vecchio Blanco, Giovanni Monteleone, Alessandro Repici, Teoh Anthony Yuen Bun AYB Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong 999077, China., and Andrea Anderloni.
• Department of Systems Medicine, University of Rome "Tor Vergata", Napoli 80129, Italy.
• World J. Gastroenterol. 2020 Apr 28; 26 (16): 1847-1860.

AbstractMalignant 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 intake. MGOO is mainly secondary to advanced pancreatic or gastric cancers, and significantly impacts on patients' survival and quality of life. Patients suffering from this condition often present with intractable vomiting and severe malnutrition, which further compromise therapeutic chances. Currently, palliative strategies are based primarily on surgical gastrojejunostomy and endoscopic enteral stenting with self-expanding metal stents. Several 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 stay. On 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 re-interventions. Recently, a third way has come from interventional endoscopic ultrasound, through the development of endoscopic ultrasound-guided gastroenterostomy technique with lumen-apposing metal stent. This 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 lacking. In 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.©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

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