Evidence-based, cost-effective management of gastric outlet obstruction: An algorithm of the Journal of Trauma and Acute Care Surgery, Emergency General Surgery Algorithms Work Group

ABSTRACT: Gastric outlet obstruction (GOO) can result from several etiologies. GOO due to peptic ulcer disease occurs in fewer than 5% of all patients with complicated duodenal ulcers and in <1% to 2% of those with gastric ulcers. Malignant disease is now a more common etiology. Patients with GOO present with severe vomiting, abdominal pain, severe dehydration, and electrolyte derangement requiring resuscitation. The initial imaging evaluation is a computed tomography scan with po contrast, which will demonstrate the obstruction and possible etiologies. An EGD should be done to assess the degree of GOO structure and obtain a tissue biopsy. The management of benign GOO can range from balloon dilation that can be repeated or consider other endoscopic options. Surgical management of severe GOO is occasionally required with either pyloroplasty or resection of the GOO with a Billroth I/II or Roux-en-Y reconstruction. Management of malignant disease can become complex, as the initial goal would be operative management of resectable malignant disease. If not resectable, there are several endoscopic alternatives to bypassing an obstruction. Surgical bypass options with a Billroth II are still an option.