Storm Andrew C, Ryou Marvin
Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Curr Opin Gastroenterol. 2017 Nov;33(6):455-460. doi: 10.1097/MOG.0000000000000403.
Disorders of gastric outflow and outlet obstruction include a variety of benign and malignant disorders such as peptic strictures, foreign bodies, gastroparesis, and cancers of the stomach, duodenum, and pancreas. Historically, a majority of patients presenting with gastric outlet obstruction (GOO) were to the result of peptic ulcers and surgical management of peptic ulcer complications was a mainstay of general surgical training. Invasive surgery is being performed less frequently today due to realization of the role of Helicobacter pylori in peptic ulcer disease and the introduction of novel endoscopic techniques for management of GOO.
For malignant GOO, the introduction of lumen-apposing metal stents have opened the door for the development and performance of endoscopic ultrasound-guided gastric bypass procedures. For benign GOO, including gastroparesis and pyloric stenosis, endoscopic myotomy shows promise.
Endoscopic ultrasound-guided gastric bypass, per-oral endoscopic myotomy, and other novel techniques in the endoscopic management of GOO, are discussed in this review.
胃流出道及出口梗阻性疾病包括多种良性和恶性疾病，如消化性狭窄、异物、胃轻瘫以及胃、十二指肠和胰腺的癌症。从历史上看，大多数表现为胃出口梗阻（GOO）的患者是由消化性溃疡引起的，消化性溃疡并发症的外科治疗是普通外科培训的主要内容。如今，由于认识到幽门螺杆菌在消化性溃疡疾病中的作用以及新型内镜技术用于GOO的治疗，侵入性手术的开展频率降低。
对于恶性GOO，管腔贴附金属支架的引入为内镜超声引导下胃旁路手术的发展和实施打开了大门。对于包括胃轻瘫和幽门狭窄在内的良性GOO，内镜下肌切开术显示出前景。
本综述讨论了内镜超声引导下胃旁路手术、经口内镜下肌切开术以及GOO内镜治疗中的其他新技术。
