During these exams, the patient swallows contrast and then has X-rays taken to track the migration of the contrast. In a patient with GOO, the contrast would have a significantly delayed gastric emptying time and reduced migration through the small bowel.

Sometimes the contrast studies can be technically difficult to perform and may be challenging for the patient to complete especially if the GOO is severe.


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Computed tomography (CT) of the abdomen and pelvis can also be performed, which provides cross-sectional imaging that may be helpful in identifying the underlying cause of the GOO.

An abdominal ultrasound may be helpful in identifying gallstones, dilated biliary ducts, or retained fluid in the stomach, however they are not typically the imaging test of choice.

After the appropriate imaging, endoscopy (eg, esophagogastroduodenoscopy) is often performed to assist in providing a definitive diagnosis of the underlying cause of the GOO. A nasogastric tube can sometimes be placed prior to the endoscopy in order to decompress the stomach and avoid aspiration.

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The endoscopy can be used to obtain biopsies of suspicious areas that may have been identified on prior imaging. In addition to esophagogastroduodenoscopy, endoscopic retrograde cholangiopancreaticography (ERCP) and endoscopic ultrasound (EUS) can be used for more challenging cases.

Besides obtaining tissue samples, endoscopy can also be used to place stents to relieve the obstruction.5 If endoscopic stenting is not an option for a patient, then the patient can be evaluated for potential surgical interventions.

References

  1. Peterson MC, Holbrook JH, Von Hales D, et al. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med. 1992;156(2):163-165.
  2. Chowdhury A, Dhali GK, Banerjee PK. Etiology of gastric outlet obstruction. Am J Gastroenterol. 1996 Aug;91(8):1679.
  3. Shone DN, Nikoomanesh P, Smith-Meek MM, Bender JS. Malignancy is the most common cause of gastric outlet obstruction in the era of H2 blockers. Am J Gastroenterol. 1995;90(10):1769-1770.
  4. Tendler DA. Malignant gastric outlet obstruction: bridging another divide. Am J Gastroenterol. 2002;97(1):4-6.
  5. Tringali A, Didden P, Repici A, et al. Endoscopic treatment of malignant gastric and duodenal strictures: a prospective, multicenter study. Gastrointest Endosc. 2014;79(1):66-75.