A Study of Clinical Presentation and Management of Malignant Gastric Outlet Obstruction (Northeast India-Based Single-Centre Experience).

Abstract

Gastric outlet obstruction (GOO) occurs when there is mechanical obstruction impending gastric emptying. GOO has both benign and malignant aetiologies. In this paper we want to discuss, clinical presentation and management of malignant GOO. This is a retrospective observational study of 5years in patients presenting with malignant GOO. Study was conducted in Dr. B. Borooah Cancer Institute, Guwahati, India. Patients with malignant GOO who were operated were included in this study. Chi-square test was used to evaluate association between categorical values. Independent t test and one-way ANOVA (analysis of variance) was used for continuous variables. A p value < 0.05 was considered statistically significant at 95% confidence interval. Data were analysed using SPSS (Statistical Package for the Social Sciences) software. A total of 107 patients were included in the study. Mean age of patients was 51years. Carcinoma stomach was the most common cause of GOO, followed by carcinoma gall bladder, pancreatic cancer and duodenal cancer in decreasing order of frequency. Gastrojejunostomy was done in 96 patients, and palliative gastrectomy with gastrojejunostomy was done in 11 patients. There was improvement in gastric outlet obstruction score in most of the patients after GJ with acceptable patency rates at the end of 90days. Low albumin levels and poor preoperative performance status were associated with increased 90-day mortality. Patients with malignant GOO usually present in poor general condition. Carcinoma stomach was the major cause of GOO in our setup. Adequate preoperative resuscitation, nutritional assessment and correction of malnourishment are of utmost importance for improving outcome of patients. Surgical gastroenterostomy was effective for palliation of obstructive symptoms in our study with improvement in post-operative oral intake and improved quality of life. Our study of 107 patients with GOO has shown that surgical palliation of GOO in the form of gastrojejunostomy improves oral intake of patients with improved post-operative gastric-outlet obstruction scores. Low albumin levels and poor preoperative poor performance status were associated with increased mortality at the end of 90days.