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Benign gastric outlet obstruction — ESEGH MCQ

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HardLuminal GIBenign gastric outlet obstructionESEGH

A 52-year-old man is admitted with recurrent post-prandial epigastric pain, early satiety and large-volume non-bilious vomiting. After gastric decompression and correction of his electrolyte disturbance, endoscopy shows retained food and a short, scarred, non-traversable pyloric-channel stricture without active ulceration. Repeat endoscopy with multiple biopsies shows no dysplasia or malignancy. Contrast-enhanced CT shows no gastric mass, pathological lymphadenopathy or extrinsic compression. Helicobacter pylori testing is positive, and multidisciplinary review concludes that this is benign peptic gastric outlet obstruction. What is the most appropriate definitive management strategy?

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Correct answer: A — Proton-pump inhibition, H. pylori eradication and graded endoscopic balloon dilatation

This is a fixed, fibrotic benign peptic pyloric stricture rather than transient obstruction from active inflammatory oedema. Management should address both components: proton-pump inhibition and H. pylori eradication treat the ulcer diathesis, while graded endoscopic balloon dilatation relieves the mechanical obstruction. Medical treatment alone is unlikely to open a scarred, non-traversable stricture. Enteral stenting is principally used for malignant obstruction and is not standard first-line treatment for this short benign stricture. Gastrojejunostomy or other surgery is reserved for failed, recurrent or complicated endoscopic treatment. Botulinum toxin injection and gastric peroral endoscopic myotomy target pyloric dysfunction in selected patients with gastroparesis, not a structural fibrotic stenosis.

Reference: Jeong SJ, Lee J. Management of gastric outlet obstruction: Focusing on endoscopic approach. World Journal of Gastrointestinal Pharmacology and Therapeutics. 2020;11(2):8-16. https://pubmed.ncbi.nlm.nih.gov/32550041/