Interventional Options for Malignant Upper GI Obstruction, 2nd ed

Background

Patients with unresectable cancers of the upper gastrointestinal tract often suffer severe symptoms due to pain, nausea and vomiting, weight loss, cachexia, and poor food tolerance. This can be related to gastric and duodenal cancers causing intrinsic obstruction of the intestinal lumen or pancreatic and biliary cancers causing extrinsic biliary compression. Management options vary depending on the site of obstruction, the patient’s functional status, the patient-defined goals of care, and estimated prognosis. Fast Fact #45 discussed medical management options. This Fact Fact reviews interventional approaches for upper GI obstructions, especially when further radiation, chemotherapy, medical management, or curative surgical options are longer helpful. Listed below are treatment options for managing different sites of obstruction (listed from least invasive to most invasive). Management decisions for these problems are complex, requiring a multi-disciplinary approach (involving surgery, gastroenterology, medical and radiation oncology, radiology, and palliative care) to achieve the best possible outcome with minimum morbidity.