ABSTRACT
The development of GOO or proximal gastrointestinal obstruction in a patient with a known background of advanced malignant disease portends a generally poor prognosis. Though reports in the literature have been variable, recent prospective observational studies report a median overall survival of approximately 64 days in patients who develop GOO secondary to unresected primary or
28.1 Introduction .......................................................................................................................... 331 28.1.1 Acute Presentation of GOO ...................................................................................... 331 28.1.2 Clinical Presentation................................................................................................. 332 28.1.3 Diagnostic Evaluation ............................................................................................... 332
28.2 Nutritional Complications of GOO ...................................................................................... 333 28.2.1 Proximal GOO .......................................................................................................... 333 28.2.2 Duodenal and Biliary Obstruction ........................................................................... 333 28.2.3 Pancreatic Duct Obstruction ..................................................................................... 334 28.2.4 Nutritional Dešciencies ............................................................................................ 335
28.3 Surgical Techniques .............................................................................................................. 335 28.3.1 Gastrojejunostomy .................................................................................................... 335 28.3.2 Risks Associated with Gastrojejunostomy ............................................................... 336 28.3.3 Partial Stomach-Partitioning Gastrojejunostomy ..................................................... 336 28.3.4 Role of Prophylactic Gastrojejunostomy .................................................................. 336
28.4 Biliary Obstruction ............................................................................................................... 337 28.5 Minimally Invasive Surgical Techniques ............................................................................. 337 28.6 Non-Surgical Options ........................................................................................................... 338 28.7 Guidelines ............................................................................................................................. 339 Ethical Issues ................................................................................................................................. 339 Summary Points .............................................................................................................................340 List of Abbreviations ......................................................................................................................340 References ......................................................................................................................................340
the development of GOO, symptom relief and overall quality of life should be paramount in discussions of treatment options for patients. The performance status of the patient and their capacity to undergo interventional procedures and, as necessary, repeat interventions should be considered. Various palliative surgical techniques have been employed and studied over the past two decades (Nakakura and Warren 2007).
