Malignant Gastric Outlet Obstruction from Pancreatic Cancer

Principles of Palliative and Supportive Care in Pancreatic Cancer: A Review

Pancreatic adenocarcinoma (PDAC) is well known for its poor survival time. Clinical symptoms are painless jaundice or abdominal or back pain. Less specific symptoms often appear that make diagnosis difficult, e.g., weight loss, loss of appetite, nausea and vomiting, and general weakness. Only 10-20% of patients are diagnosed at an early stage. A cure is practically only possible with a radical surgical operation. In the case of locally advanced findings, neoadjuvant therapy is administered. Among the therapeutic options offered are chemotherapy, radiotherapy (including stereotactic radiotherapy-SBRT), targeted treatment, or immunotherapy. In the case of metastatic disease, of which more than half are present at diagnosis, the goal is to relieve the patient of problems. Metastatic PDAC can cause problems arising from the localization of distant metastases, but it also locally affects the organs it infiltrates. In our review article, we focus on the largest group of patients, those with locally advanced disease and metastatic disease-symptoms related to the infiltration or destruction of the pancreatic parenchyma and the growth of the tumor into the surrounding. Therefore, we deal with biliary or duodenal obstruction, gastric outlet syndrome, bleeding and thromboembolic diseases, pain, depression, and fatigue, as well as pancreatic exocrine insufficiency and malnutrition. Metastatic spread is most often to the liver, peritoneum, or lungs. The presented overview aims to offer current therapeutic options across disciplines. In accordance with modern oncology, a multidisciplinary approach with a procedure tailored to the specific patient remains the gold standard.

EUS-guided stent placement for afferent limb and gastrojejunal obstruction in a patient with pancreatic cancer

Video 1EUS-guided stent placement for afferent limb and gastrojejunal obstruction in a patient with pancreatic cancer.

Gastric Outlet Obstruction Secondary to Pyloric Thickening in an Adolescent Male

Gastric outlet obstruction secondary to pyloric thickening in adolescents is an extremely rare finding. The condition is caused by a number of benign or malignant etiologies that cause an impediment to gastric emptying. Common and uncommon etiologies as well as the pathogenesis of gastric outlet obstruction are discussed. A case study of gastric outlet obstruction in a 14-year-old male is presented, and the crucial role of sonography in the diagnostic process of his condition is considered.