Medical and Endoscopic Management of Gastric Outlet Obstruction

  • Cheyenne C. Sonntag
  • Eric M. PauliEmail author


This chapter discusses the evaluation, medical management, and diagnosis of GOO, as well as explores endoscopic management options for both benign and malignant disease. Endoscopic therapies discussed include through-the-scope balloon dilation, botulinum toxin injection, self-expandable metal stents, and decompressive percutaneous endoscopic gastrostomy tube placement. Additionally, a brief overview of novel and developing therapies including peroral endoscopic pyloromyotomy, gastrojejunostomy with lumen-apposing metal stents, and gastrojejunostomy formation with self-assembling magnets is provided.


Gastric outlet obstruction Endoscopic management Medical management Endoscopic balloon dilation Self-expandable metal stents Botulinum toxin Botox Peroral endoscopic pyloromyotomy G-POEM EUS-guided gastrojejunostomy LAMS gastrojejunostomy Decompressive PEG 


  1. 1.
    Ellis H. The diagnosis of benign and malignant pyloric obstruction. Clin Oncol. 1976;2(1):11–5.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Johnson CD, Ellis H. Gastric outlet obstruction now predicts malignancy. Br J Surg. 1990;77(9):1023–4.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Khullar SK, DiSario JA. Gastric outlet obstruction. Gastrointest Endosc Clin N Am. 1996;6(3):585–603.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Milosavljevic T, et al. Complications of peptic ulcer disease. Dig Dis. 2011;29(5):491–3.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chaudhary A, et al. Elective surgery for corrosive-induced gastric injury. World J Surg. 1996;20(6):703–6. discussion 706CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Reynolds HL Jr, Stellato TA. Crohn’s disease of the foregut. Surg Clin North Am. 2001;81(1):117–35. viiiCrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Scheck SM, et al. Crohn’s disease presenting as gastric outlet obstruction. J Surg Case Rep. 2014;2014(12):1–3.Google Scholar
  8. 8.
    Padmanabhan H, Rothnie A, Singh P. An unusual case of gastric outlet obstruction caused by tuberculosis: challenges in diagnosis and treatment. BMJ Case Rep. 2013;2013:1–5.Google Scholar
  9. 9.
    Weil BR, Howard TJ, Zyromski NJ. Spontaneous duodenal hematoma: a rare cause of upper gastrointestinal tract obstruction. Arch Surg. 2008;143(8):794–6.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Dean PG, et al. Hyperplastic gastric polyp causing progressive gastric outlet obstruction. Mayo Clin Proc. 1998;73(10):964–7.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Qasaimeh GR, Bakkar S, Jadallah K. Bouveret’s syndrome: an overlooked diagnosis. A case report and review of literature. Int Surg. 2014;99(6):819–23.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol. 2002;97(1):72–8.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Asano N, et al. Helicobacter pylori-negative gastric mucosa-associated lymphoid tissue lymphomas: a review. World J Gastroenterol. 2015;21(26):8014–20.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lightner AL, et al. Primary gastrointestinal non-Hodgkin’s lymphoma of the small and large intestines: a systematic review. J Gastrointest Surg. 2016;20(4):827–39.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Pauli EM, Marks JM, editors. Percutaneous Endoscopic Gastrostomy (PEG): techniques, effectiveness, and potential complications. New York: Nova Biomedical; 2016. p. 125–39.Google Scholar
  16. 16.
    Jaffin BW, Kaye MD. The prognosis of gastric outlet obstruction. Ann Surg. 1985;201(2):176–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Weiland D, et al. Gastric outlet obstruction in peptic ulcer disease: an indication for surgery. Am J Surg. 1982;143(1):90–3.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Johnston D, et al. Highly selective vagotomy without a drainage procedure in the treatment of haemorrhage, perforation, and pyloric stenosis due to peptic ulcer. Br J Surg. 1973;60(10):790–7.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kozarek RA, Botoman VA, Patterson DJ. Long-term follow-up in patients who have undergone balloon dilation for gastric outlet obstruction. Gastrointest Endosc. 1990;36(6):558–61.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Benjamin SB, Cattau EL, Glass RL. Balloon dilation of the pylorus: therapy for gastric outlet obstruction. Gastrointest Endosc. 1982;28(4):253–4.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Hogan RB, Hamilton JK, Polter DE. Preliminary experience with hydrostatic balloon dilation of gastric outlet obstruction. Gastrointest Endosc. 1986;32(2):71–4.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Cherian PT, Cherian S, Singh P. Long-term follow-up of patients with gastric outlet obstruction related to peptic ulcer disease treated with endoscopic balloon dilatation and drug therapy. Gastrointest Endosc. 2007;66(3):491–7.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Kochhar R, Kochhar S. Endoscopic balloon dilation for benign gastric outlet obstruction in adults. World J Gastrointest Endosc. 2010;2(1):29–35.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Solt J, Hertelendi A, Szilagyi K. Balloon catheter dilatation of lower gastrointestinal tract stenoses: long-term results. Orv Hetil. 2002;143(31):1835–40.PubMedPubMedCentralGoogle Scholar
  25. 25.
    Boylan JJ, Gradzka MI. Long-term results of endoscopic balloon dilatation for gastric outlet obstruction. Dig Dis Sci. 1999;44(9):1883–6.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Solt J, et al. Long-term results of balloon catheter dilation for benign gastric outlet stenosis. Endoscopy. 2003;35(6):490–5.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Murthy UK. Repeated hydrostatic balloon dilation in obstructive gastroduodenal Crohn’s disease. Gastrointest Endosc. 1991;37(4):484–5.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Kim JH, et al. Benign duodenal strictures: treatment by means of fluoroscopically guided balloon dilation. J Vasc Interv Radiol. 2005;16(4):543–8.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Goldstein JA, Barkin JS. Comparison of the diameter consistency and dilating force of the controlled radial expansion balloon catheter to the conventional balloon dilators. Am J Gastroenterol. 2000;95(12):3423–7.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Committee, A.S.o.P., et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc. 2015;81(1):81–9.CrossRefGoogle Scholar
  31. 31.
    Geist SM, Fitzpatrick S, Geist JR. American Heart Association 2007 guidelines on prevention of infective endocarditis. J Mich Dent Assoc. 2007;89(9):50–6.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Nishimura RA, et al. ACC/AHA 2008 guideline update on valvular heart disease: focused update on infective endocarditis: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(8):887–96.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kim JH, et al. Gastric outlet obstruction caused by benign anastomotic stricture: treatment by fluoroscopically guided balloon dilation. J Vasc Interv Radiol. 2005;16(5):699–704.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Rana SS, et al. Endoscopic balloon dilatation without fluoroscopy for treating gastric outlet obstruction because of benign etiologies. Surg Endosc. 2011;25(5):1579–84.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Kochhar R, et al. Early endoscopic balloon dilation in caustic-induced gastric injury. Gastrointest Endosc. 2010;71(4):737–44.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Kochhar R, et al. Endoscopic balloon dilatation of benign gastric outlet obstruction. J Gastroenterol Hepatol. 2004;19(4):418–22.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Lam YH, et al. Endoscopic balloon dilation for benign gastric outlet obstruction with or without Helicobacter pylori infection. Gastrointest Endosc. 2004;60(2):229–33.CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Ukleja A, et al. Outcome of endoscopic balloon dilation of strictures after laparoscopic gastric bypass. Surg Endosc. 2008;22(8):1746–50.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Lau JY, et al. Through-the-scope balloon dilation for pyloric stenosis: long-term results. Gastrointest Endosc. 1996;43(2 Pt 1):98–101.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Kirk RM. The size of the pyloroduodenal canal: its relation to the cause and treatment of peptic ulcer. Proc R Soc Med. 1970;63(9):944–6.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Perng CL, et al. Characteristics of patients with benign gastric outlet obstruction requiring surgery after endoscopic balloon dilation. Am J Gastroenterol. 1996;91(5):987–90.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Kochhar R, et al. Intralesional steroid injections for corrosive induced pyloric stenosis. Endoscopy. 1998;30(8):734–6.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Singh VV, Draganov P, Valentine J. Efficacy and safety of endoscopic balloon dilation of symptomatic upper and lower gastrointestinal Crohn’s disease strictures. J Clin Gastroenterol. 2005;39(4):284–90.CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Pasricha PJ, Ravich WJ, Kalloo AN. Botulinum toxin for achalasia. Lancet. 1993;341(8839):244–5.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Bashashati M, et al. Botulinum toxin in the treatment of diffuse esophageal spasm. Dis Esophagus. 2010;23(7):554–60.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Jost WH, Schimrigk K. Use of botulinum toxin in anal fissure. Dis Colon Rectum. 1993;36(10):974.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Clarke JO, Snape WJ Jr. Pyloric sphincter therapy: botulinum toxin, stents, and pyloromyotomy. Gastroenterol Clin N Am. 2015;44(1):127–36.CrossRefGoogle Scholar
  48. 48.
    Coleski R, Anderson MA, Hasler WL. Factors associated with symptom response to pyloric injection of botulinum toxin in a large series of gastroparesis patients. Dig Dis Sci. 2009;54(12):2634–42.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Kent MS, et al. A pilot study of botulinum toxin injection for the treatment of delayed gastric emptying following esophagectomy. Surg Endosc. 2007;21(5):754–7.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Wiesel PH, et al. Botulinum toxin for refractory postoperative pyloric spasm. Endoscopy. 1997;29(2):132.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Arts J, et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26(9):1251–8.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Camilleri M, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18–37. quiz 38CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Heinen F, et al. Lack of response to botulinum toxin A in patients with hypertrophic pyloric stenosis. Eur J Pediatr. 1999;158(5):436.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Bromer MQ, et al. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc. 2005;61(7):833–9.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Huibregtse K, et al. Endoscopic placement of expandable metal stents for biliary strictures – a preliminary report on experience with 33 patients. Endoscopy. 1989;21(6):280–2.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Pinto Pabon IT, et al. Gastric and duodenal stents: follow-up and complications. Cardiovasc Intervent Radiol. 2001;24(3):147–53.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Binkert CA, et al. Benign and malignant stenoses of the stomach and duodenum: treatment with self-expanding metallic endoprostheses. Radiology. 1996;199(2):335–8.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Bae JI, et al. Treatment of a benign anastomotic duodenojejunal stricture with a polytetrafluoroethylene-covered retrievable expandable nitinol stent. J Vasc Interv Radiol. 2004;15(7):769–72.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Baerlocher MO, et al. Interdisciplinary Canadian guidelines on the use of metal stents in the gastrointestinal tract for oncological indications. Can Assoc Radiol J. 2008;59(3):107–22.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Mangiavillano B, et al. Role of stenting in gastrointestinal benign and malignant diseases. World J Gastrointest Endosc. 2015;7(5):460–80.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Brimhall B, Adler DG. Enteral stents for malignant gastric outlet obstruction. Gastrointest Endosc Clin N Am. 2011;21(3):389–403. vii-viiiCrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Jeurnink SM, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2010;71(3):490–9.CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Miyazaki Y, et al. Treatment of gastric outlet obstruction that results from unresectable gastric cancer: current evidence. World J Gastrointest Endosc. 2016;8(3):165–72.CrossRefPubMedPubMedCentralGoogle Scholar
  64. 64.
    Lopera JE, et al. Gastroduodenal stent placement: current status. Radiographics. 2004;24(6):1561–73.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Potz BA, Miner TJ. Surgical palliation of gastric outlet obstruction in advanced malignancy. World J Gastrointest Surg. 2016;8(8):545–55.CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Maetani I, et al. Metallic stents for gastric outlet obstruction: reintervention rate is lower with uncovered versus covered stents, despite similar outcomes. Gastrointest Endosc. 2009;69(4):806–12.CrossRefPubMedPubMedCentralGoogle Scholar
  67. 67.
    Ly J, et al. A systematic review of methods to palliate malignant gastric outlet obstruction. Surg Endosc. 2010;24(2):290–7.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    Bian SB, et al. Palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer: a meta-analysis comparison of gastrojejunostomy with endoscopic stenting. Chin Med J. 2016;129(9):1113–21.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Kochar R, Shah N. Enteral stents: from esophagus to colon. Gastrointest Endosc. 2013;78(6):913–8.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Tsauo J, et al. Partially-covered stent placement versus surgical gastrojejunostomy for the palliation of malignant gastroduodenal obstruction secondary to pancreatic cancer. Abdom Radiol (NY). 2016;41(11):2233–40.CrossRefGoogle Scholar
  71. 71.
    Minata MK, et al. Stents and surgical interventions in the palliation of gastric outlet obstruction: a systematic review. Endosc Int Open. 2016;4(11):E1158–70.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Kim JW, et al. Comparison between uncovered and covered self-expandable metal stent placement in malignant duodenal obstruction. World J Gastroenterol. 2015;21(5):1580–7.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Pan YM, et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant gastric outlet obstruction: a systematic review and meta-analysis. BMC Gastroenterol. 2014;14:170.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Kim CG, et al. Covered versus uncovered self-expandable metallic stents for palliation of malignant pyloric obstruction in gastric cancer patients: a randomized, prospective study. Gastrointest Endosc. 2010;72(1):25–32.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Yamao K, et al. Factors predicting through-the-scope gastroduodenal stenting outcomes in patients with gastric outlet obstruction: a large multicenter retrospective study in West Japan. Gastrointest Endosc. 2016;84(5):757–63. e6CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Jung K, et al. Outcomes of endoscopically inserted self-expandable metal stents in malignancy according to the type of stent and the site of obstruction. Surg Endosc. 2016;30(9):4001–10.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Bethge N, et al. Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc. 1996;43(6):596–602.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.
    Vakil N. Expandable metal stents: principles and tissue responses. Gastrointest Endosc Clin N Am. 2011;21(3):351–7. viiCrossRefPubMedPubMedCentralGoogle Scholar
  79. 79.
    Maetani I, Isayama H, Mizumoto Y. Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: a multicenter study. Gastrointest Endosc. 2007;66(2):355–60.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.
    Woo SM, et al. Comparison of uncovered and covered stents for the treatment of malignant duodenal obstruction caused by pancreaticobiliary cancer. Surg Endosc. 2013;27(6):2031–9.CrossRefPubMedPubMedCentralGoogle Scholar
  81. 81.
    Dormann AJ, Deppe H, Wigginghaus B. Self-expanding metallic stents for continuous dilatation of benign stenoses in gastrointestinal tract – first results of long-term follow-up in interim stent application in pyloric and colonic obstructions. Z Gastroenterol. 2001;39(11):957–60.CrossRefPubMedPubMedCentralGoogle Scholar
  82. 82.
    Johnsson E, Thune A, Liedman B. Palliation of malignant gastroduodenal obstruction with open surgical bypass or endoscopic stenting: clinical outcome and health economic evaluation. World J Surg. 2004;28(8):812–7.CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Gaidos JK, Draganov PV. Treatment of malignant gastric outlet obstruction with endoscopically placed self-expandable metal stents. World J Gastroenterol. 2009;15(35):4365–71.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Jeurnink SM, et al. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18.CrossRefPubMedPubMedCentralGoogle Scholar
  85. 85.
    No JH, et al. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc. 2013;78(1):55–62.CrossRefPubMedPubMedCentralGoogle Scholar
  86. 86.
    Grunwald D, et al. The location of obstruction predicts stent occlusion in malignant gastric outlet obstruction. Therap Adv Gastroenterol. 2016;9(6):815–22.CrossRefPubMedPubMedCentralGoogle Scholar
  87. 87.
    Kim ID, et al. Prevention of covered enteral stent migration in patients with malignant gastric outlet obstruction: a pilot study of anchoring with endoscopic clips. Scand J Gastroenterol. 2010;45(1):100–5.CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Baron TH. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344(22):1681–7.CrossRefPubMedPubMedCentralGoogle Scholar
  89. 89.
    Dolan EA. Malignant bowel obstruction: a review of current treatment strategies. Am J Hosp Palliat Care. 2011;28(8):576–82.CrossRefPubMedPubMedCentralGoogle Scholar
  90. 90.
    Schmidt C, et al. A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. Am J Surg. 2009;198(1):92–9.CrossRefPubMedPubMedCentralGoogle Scholar
  91. 91.
    Teriaky A, Gregor J, Chande N. Percutaneous endoscopic gastrostomy tube placement for end-stage palliation of malignant gastrointestinal obstructions. Saudi J Gastroenterol. 2012;18(2):95–8.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Issaka RB, et al. Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction. Surg Endosc. 2014;28(5):1668–73.CrossRefPubMedPubMedCentralGoogle Scholar
  93. 93.
    Lipp A, Lusardi G. Systemic antimicrobial prophylaxis for percutaneous endoscopic gastrostomy. Cochrane Database Syst Rev. 2013;11:CD005571.Google Scholar
  94. 94.
    Campagnutta E, et al. Palliative treatment of upper intestinal obstruction by gynecological malignancy: the usefulness of percutaneous endoscopic gastrostomy. Gynecol Oncol. 1996;62(1):103–5.CrossRefPubMedPubMedCentralGoogle Scholar
  95. 95.
    Duncan HD, et al. Prospective randomized comparison of two different sized percutaneous endoscopically placed gastrostomy tubes. Clin Nutr. 1996;15(6):317–20.CrossRefPubMedPubMedCentralGoogle Scholar
  96. 96.
    Udomsawaengsup S, et al. Percutaneous transesophageal gastrostomy (PTEG): a safe and effective technique for gastrointestinal decompression in malignant obstruction and massive ascites. Surg Endosc. 2008;22(10):2314–8.CrossRefPubMedPubMedCentralGoogle Scholar
  97. 97.
    Oishi H, et al. A nonsurgical technique to create an esophagostomy for difficult cases of percutaneous endoscopic gastrostomy. Surg Endosc. 2003;17(8):1224–7.CrossRefPubMedPubMedCentralGoogle Scholar
  98. 98.
    Brooksbank MA, Game PA, Ashby MA. Palliative venting gastrostomy in malignant intestinal obstruction. Palliat Med. 2002;16(6):520–6.CrossRefPubMedPubMedCentralGoogle Scholar
  99. 99.
    McClave SA, Ritchie CS. The role of endoscopically placed feeding or decompression tubes. Gastroenterol Clin N Am. 2006;35(1):83–100.CrossRefGoogle Scholar
  100. 100.
    Kawai M, et al. Endoscopic pyloromyotomy: a new concept of minimally invasive surgery for pyloric stenosis. Endoscopy. 2012;44(2):169–73.CrossRefPubMedPubMedCentralGoogle Scholar
  101. 101.
    Khashab MA, et al. Gastric peroral endoscopic myotomy for refractory gastroparesis: first human endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2013;78(5):764–8.CrossRefPubMedPubMedCentralGoogle Scholar
  102. 102.
    Chung H, et al. Endoscopic pyloromyotomy for postesophagectomy gastric outlet obstruction. Endoscopy. 2014;46 Suppl 1 UCTN:E345–6.PubMedPubMedCentralGoogle Scholar
  103. 103.
    Pham KD, et al. Peroral endoscopic pyloromyotomy for primary pyloric stenosis. Endoscopy. 2015;47(Suppl 1):E637–8.PubMedPubMedCentralGoogle Scholar
  104. 104.
    Shlomovitz E, et al. Early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc. 2015;29(3):543–51.CrossRefGoogle Scholar
  105. 105.
    Gonzalez JM, et al. Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video). Gastrointest Endosc. 2017;85(1):132–9.CrossRefPubMedPubMedCentralGoogle Scholar
  106. 106.
    Khashab MA, et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2017;85(1):123–8.CrossRefPubMedPubMedCentralGoogle Scholar
  107. 107.
    Camilleri M, Szarka LA. POEMs for gastroparesis. Gastrointest Endosc. 2017;85(1):129–31.CrossRefPubMedPubMedCentralGoogle Scholar
  108. 108.
    Pichakron KO, et al. Magnamosis II: magnetic compression anastomosis for minimally invasive gastrojejunostomy and jejunojejunostomy. J Am Coll Surg. 2011;212(1):42–9.CrossRefPubMedPubMedCentralGoogle Scholar
  109. 109.
    Jamshidi R, et al. Magnamosis: magnetic compression anastomosis with comparison to suture and staple techniques. J Pediatr Surg. 2009;44(1):222–8.CrossRefPubMedPubMedCentralGoogle Scholar
  110. 110.
    Gonzales KD, et al. Magnamosis III: delivery of a magnetic compression anastomosis device using minimally invasive endoscopic techniques. J Pediatr Surg. 2012;47(6):1291–5.CrossRefPubMedPubMedCentralGoogle Scholar
  111. 111.
    Chopita N, et al. Endoscopic gastroenteric anastomosis using magnets. Endoscopy. 2005;37(4):313–7.CrossRefPubMedPubMedCentralGoogle Scholar
  112. 112.
    Cope C, et al. Stent placement of gastroenteric anastomoses formed by magnetic compression. J Vasc Interv Radiol. 1999;10(10):1379–86.CrossRefPubMedPubMedCentralGoogle Scholar
  113. 113.
    Ryou M, Agoston AT, Thompson CC. Endoscopic intestinal bypass creation by using self-assembling magnets in a porcine model. Gastrointest Endosc. 2016;83(4):821–5.CrossRefPubMedPubMedCentralGoogle Scholar
  114. 114.
    Ryou M, et al. Smart Self-Assembling MagnetS for ENdoscopy (SAMSEN) for transoral endoscopic creation of immediate gastrojejunostomy (with video). Gastrointest Endosc. 2011;73(2):353–9.CrossRefPubMedPubMedCentralGoogle Scholar
  115. 115.
    Ryou M, Aihara H, Thompson CC. Minimally invasive entero-enteral dual-path bypass using self-assembling magnets. Surg Endosc. 2016;30(10):4533–8.CrossRefPubMedPubMedCentralGoogle Scholar
  116. 116.
    Barthet M, et al. Natural orifice transluminal endoscopic surgery gastroenterostomy with a biflanged lumen-apposing stent: first clinical experience (with videos). Gastrointest Endosc. 2015;81(1):215–8.CrossRefPubMedPubMedCentralGoogle Scholar
  117. 117.
    Tyberg A, et al. EUS-guided gastrojejunostomy after failed enteral stenting. Gastrointest Endosc. 2015;81(4):1011–2.CrossRefPubMedPubMedCentralGoogle Scholar
  118. 118.
    Tyberg A, et al. Endoscopic ultrasound-guided gastrojejunostomy with a lumen-apposing metal stent: a multicenter, international experience. Endosc Int Open. 2016;4(3):E276–81.CrossRefPubMedPubMedCentralGoogle Scholar
  119. 119.
    Khashab MA, et al. EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc. 2015;82(5):932–8.CrossRefPubMedPubMedCentralGoogle Scholar
  120. 120.
    Itoi T, et al. Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc. 2017;29(4):495–502.CrossRefPubMedPubMedCentralGoogle Scholar
  121. 121.
    Itoi T, et al. Novel EUS-guided double-balloon-occluded gastrojejunostomy bypass. Gastrointest Endosc. 2016;83(2):461–2.CrossRefPubMedPubMedCentralGoogle Scholar
  122. 122.
    Chen YI, et al. EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc. 2017;31(9):3765.CrossRefPubMedPubMedCentralGoogle Scholar
  123. 123.
    Pauli EM, Marks JM. Endoscopic tools and techniques for strictures and stenoses. In: Principles of flexible endoscopy for surgeons. New York: Springer; 2013. Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Division of Minimally Invasive and Bariatric Surgery, Department of SurgeryPenn State Hershey Medical CenterHersheyUSA

Personalised recommendations