This protocol applies to patients with benign gastric outlet obstruction in whom an initial endoscopic strategy has been attempted but has not achieved successful resolution of the obstruction.
Previous line: Endoscopic balloon dilation (EBD) of the benign gastroduodenal stricture, with discontinuation of NSAIDs and smoking and treatment of Helicobacter pylori infection; off-label covered self-expandable metal stent (SEMS) placement as an alternative endoscopic option.
Goal that was not achieved: Successful resolution of benign gastric outlet obstruction.
When endoscopic approaches have not resolved benign GOO, a salvage surgical approach to the gastric outlet is the next management step. Evidence in the modern era supports surgical intervention as an option with acceptable morbidity and mortality in this setting. The full procedural decision framework is in the protocol below.
There is insufficient evidence to uniformly support either endoscopic or surgical management for mixed varieties of benign GOO.
In the modern era, surgical pyloroplasty and laparoscopic GJ have been reported as acceptable treatments with low morbidity and mortality.
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