Guideline sources The following summarized guidelines for the evaluation and management of gastric outlet obstruction are prepared by our editorial team based on guidelines from the American Society for Gastrointestinal Endoscopy (ASGE 2021; 2010) and the American Gastroenterological Association (AGA 2021). 1 2 3 Guidelines 1. Diagnostic investigations Diagnostic endoscopy: perform endoscopy for the evaluation of gastric outlet obstruction in patients with peptic ulcer disease. A 2. Therapeutic procedures General principles: decide on specific interventions in patients with alimentary tract obstruction in a multidisciplinary setting including oncologists, surgeons and endoscopists and take into account the characteristics of the obstruction, patient's expectations, prognosis, expected subsequent therapies and functional status. B Endoscopic balloon dilation: consider performing endoscopic balloon dilation for gastric outlet obstruction in patients with peptic ulcer disease. C Endoscopic gastroduodenal stenting: https://web.pathway.md/diseases/recuWSpTkKFdgzFsd 1/2 6/24/23, 2:54 AM Gastric outlet obstruction Pathway p g g As per AGA 2021 guidelines: Consider placing an enteral stent in patients with gastric outlet obstruction not being candidates for gastrojejunostomy (surgical or EUS-guided). C Do not place enteral stents in patients with multiple luminal obstructions or severely impaired gastric motility because of the limited benefit in these scenarios. Consider placing venting gastrostomy in these patients. D As per ASGE 2021 guidelines, consider placing self-expandable metallic stents or performing surgical gastrojejunostomy in patients with incurable malignant gastric outlet obstruction undergoing palliative intervention. Decide between these approaches based on patient characteristics and preferences, multidisciplinary input, and local expertise. C Show 3 more 3. Surgical interventions Gastrojejunostomy: As per AGA 2021 guidelines, consider performing surgical gastrojejunostomy in patients with gastric outlet obstruction with a life expectancy > 2 months, having good functional status and being surgically fit. C Show 2 more As per ASGE 2021 guidelines, consider performing surgical gastrojejunostomy or placing self- expandable metallic stents in patients with incurable malignant gastric outlet obstruction undergoing palliative intervention. Decide between these approaches based on patient characteristics and preferences, multidisciplinary input, and local expertise. C Show 2 more References 1. ASGE Standards of Practice Committee, Terry L Jue, Andrew C Storm et al. ASGE guideline on the role of endoscopy in the management of benign and malignant gastroduodenal obstruction. Gastrointest Endosc. 2021 Feb;93 2 309 322.e4. Open 2. Osman Ahmed, Jeffrey H Lee, Christopher C Thompson et al. AGA Clinical Practice Update on the Optimal Management of the Malignant Alimentary Tract Obstruction: Expert Review. Clin Gastroenterol Hepatol. 2021 Sep;19 9 1780 1788. Open 3. ASGE Standards of Practice Committee, Subhas Banerjee, Brooks D Cash et al. The role of endoscopy in the management of patients with peptic ulcer disease. Gastrointest Endosc. 2010 Apr;71 4 663 8. Open https://web.pathway.md/diseases/recuWSpTkKFdgzFsd 2/2