Diagnostic Approach and Treatment for Gastric Hyperplasia with Gastric Outlet Obstruction

Initial Diagnostic Approach

The National Comprehensive Cancer Network recommends performing upper endoscopy immediately to visualize the obstruction, obtain multiple biopsies for histologic diagnosis, and assess feasibility of endoscopic intervention 1, 2
A CT scan with oral and IV contrast should be obtained to determine the extent of obstruction, assess for metastatic disease if malignancy is suspected, and evaluate resectability 2, 3
A complete blood count should be performed to assess for anemia from chronic bleeding 2, 3
A comprehensive metabolic panel should be evaluated to assess electrolyte abnormalities and renal function from vomiting 2, 3

The National Comprehensive Cancer Network recommends that if malignancy is confirmed, surgical resection (distal or total gastrectomy with D2 lymphadenectomy) is the primary treatment for resectable gastric cancer with obstruction 1, 4
For unresectable/metastatic disease with life expectancy >2 months, surgical gastrojejunostomy is preferred over gastrectomy 1, 2, 3
For unresectable disease with life expectancy <2 months, endoscopic self-expanding metal stent placement, not gastrectomy, is recommended 1, 2, 3

Nasogastric tube placement for gastric decompression and prevention of aspiration is recommended 2
Intravenous fluid resuscitation with isotonic crystalloids to correct dehydration and electrolyte abnormalities is recommended 2
Anti-emetics for symptom control are recommended 2
Bowel rest until obstruction is relieved is recommended 2