Gastric outlet obstruction

Fewer than 5 percent of patients develop gastric outlet obstruction, a blockage that usually occurs at or near the narrow part of the stomach (pyloric canal) as it joins the upper part of the small intestine (duodenum).

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Duodenal ulcers give rise to this complication more often than gastric ulcers. Varying degrees of obstruction may be caused by inflammatory swelling of the pyloric channel or chronic scarring.

Patients with gastric outlet obstruction usually have a history of nausea, vomiting, and pain or fullness in the upper middle part of the abdomen. Laboratory findings may show anemia and potassium abnormalities, and an X-ray typically shows a large gastric shadow with an air/fluid level. An upper GI series would show a marked delay in gastric emptying and a large stomach. Endoscopy is the best test for evaluating gastric outlet obstruction.

Endoscopic dilation of the gastric outlet is a reasonable course for treating this complication after medical therapy has failed. Balloon dilation can usually improve the acute problem. A lubricated balloon is passed through the endoscope and is inflated with water or air.

The goal of surgery for gastric outlet obstruction is twofold: 1) improvement of the obstruction, 2) treatment of the predisposing ulcer with an acid-reducing procedure. Vagotomy, in which the vagus nerve is cut to reduce stomach acid, and antrectomy, the removal of the pyloric portion of the stomach, are recommended surgical procedures.