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      Revisiting malignant gastric outlet obstruction: Where do we stand?

      editorial

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          Abstract

          The scope of management of malignant gastric outlet obstruction is ever-expanding. The therapeutic use of endoscopy is gaining popularity not just owing to its technical advancement and satisfactory patient outcomes. With technical success rates close to 96%, stent placement for palliating gastric obstruction has ensured a median survival of about 2 months post-deployment of gastro-duodenal stents. Understanding the correct concept of palliation is the need of the hour in management. Identifying the right patient for palliation, selecting the appropriate intervention and auditing the outcome are vital in delivering optimal care. Also, newer procedures such as endoscopic gastro-enterostomy offer promising outcomes in palliative care.

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          Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria

          Lynette De Groot, Gahee Lee, Antoinette Ackerie … (2020)
          Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.
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            Endoscopic gastroenterostomy: techniques and review.

            Mouen Khashab, Shayan Irani, Todd Baron … (2017)
            Gastric outlet obstruction (GOO) can result from benign and malignant causes. Until recently, surgical gastrojejunostomy was the treatment of choice for patient with benign and malignant GOO with a good functional status. Endoscopic placement of luminal self-expandable metal stents is currently widely accepted as the first line of treatment for malignant GOO because of its effectiveness and minimally invasive nature. The main shortcoming of luminal stents is the high incidence of recurrent GOO most commonly because of tumor ingrowth/overgrowth. More recently, endoscopic ultrasound (EUS)-guided gastroenterostomy (EUS-GE) has emerged as an alternative to both luminal stent placement and surgical gastrojejunostomy. Advantages of EUS-GE include its minimally invasive nature, efficacy and low incidence of recurrent GOO in cancer patient. We will describe five different techniques to perform this novel and rapidly evolving procedure using a biflanged, lumen-apposing metal stent and compare benefits and risks of each approach. These approaches include antegrade EUS-GE or 'traditional/downstream' and 'rendezvous' methods, retrograde EUS-GE or 'enterogastrostomy,'17 (EPASS), and antegrade EUS-GE 'direct' method.
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              AGA Clinical Practice Update on the Optimal Management of the Malignant Alimentary Tract Obstruction: Expert Review.

              Osman Ahmed, Jeffrey Lee, Christopher C Thompson … (2021)
              The purpose of this expert review is to describe the current methodologies available to manage malignant alimentary tract obstructions as well the evidence behind the various methods (including their efficacy and safety), indications, and appropriate timing of interventions.
              Article 0 comments Cited 29 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Krishna Kumar Govindarajan
                Journal
                Journal ID (nlm-ta): World J Gastrointest Endosc
                Journal ID (publisher-id): WJGE
                Title: World Journal of Gastrointestinal Endoscopy
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 1948-5190
                Publication date (Print): 16 January 2025
                Publication date (Electronic): 16 January 2025
                Volume: 17
                Issue: 1
                Electronic Location Identifier: 100472
                Affiliations
                Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. sasisang@ 123456rediffmail.com
                Author notes

                Author contributions: Govindarajan KK composed and reviewed.

                Corresponding author: Krishna Kumar Govindarajan, FACS, FICS, MBBS, MCh, MNAMS, MS, Professor, Department of Pediatric Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry 605006, India. sasisang@ 123456rediffmail.com

                Article
                Other ID: jWJGE.v17.i1.eid100472 Publisher-manuscript ID: 100472
                DOI: 10.4253/wjge.v17.i1.100472
                PMC ID: 11752472
                PubMed ID: 39850907
                SO-VID: 781cd8ff-3766-4463-97f9-965ba4f540ac
                Copyright © ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

                History
                Date received : 20 August 2024
                Date revision received : 23 December 2024
                Date accepted : 15 January 2025
                Categories
                Subject: Editorial

                Keywords: gastric outlet obstruction,stent,endoscopy,palliation,malnutrition
                Data availability:
                Keywords: gastric outlet obstruction, stent, endoscopy, palliation, malnutrition

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