Journal article
Diagnostic and Therapeutic Approach to Pancreatic Cancer-Associated Gastroparesis: Literature Review and Our Experience
Digestive diseases and sciences, Vol.54(2), pp.401-405
02/2009
DOI: 10.1007/s10620-008-0354-3
PMID: 18618259
Abstract
Background Patients with unresectable pancreatic carcinoma often present with early satiety, nausea, and vomiting without evidence of mechanical obstruction, mucosal disease, or metabolic abnormality. This condition is well described in the literature and is thought to result from pancreatic cancer-associated gastroparesis (PCAG). No clinical guideline is available for diagnosing and managing this rare disease. Objective To propose an algorithm for diagnosing and managing patients with PCAG based on a literature review and our clinical experience. Methods A comprehensive review was conducted of literature on the subject from 1966 to 2005, and retrospective analysis was performed for patients with PCAG who presented to the University of Iowa Hospitals and Clinics (Iowa City, IA, USA) during the period 1998–2005. Results Literature on an optimal diagnostic and therapeutic approach to PCAG is lacking. There are only two small case series and one case report regarding management of PCAG. Extensive chart review only identified two patients who met the diagnostic criteria of PCAG. We propose performing routine upper GI series and esophagogastroduodenoscopy on all patients with pancreatic cancer who present with nausea and vomiting, to rule out obstruction and mucosal disease. If there is no obstruction or mucosal disease, we do not recommend further workup. Prokinetic agents are the first line therapy for PCAG. In refractory cases, percutaneous endoscopic gastrostomy with jejunal extension may be considered in selected patients who respond to nasojejunal decompression. Conclusions We propose a time-effective and useful strategy for diagnosing and managing patients with PCAG. We also define the diagnostic end-point for this difficult to manage condition.
Details
- Title: Subtitle
- Diagnostic and Therapeutic Approach to Pancreatic Cancer-Associated Gastroparesis: Literature Review and Our Experience
- Creators
- John Leung - Gastroenterology, Internal Medicine Tufts Medical Center 800 Washington Street Boston MA 02111 USAWilliam Silverman - Gastroenterology, Internal Medicine University of Iowa Hospitals and Clinics 200 Hawkins Dr Iowa City IA 52242 USA
- Resource Type
- Journal article
- Publication Details
- Digestive diseases and sciences, Vol.54(2), pp.401-405
- Publisher
- Springer US
- DOI
- 10.1007/s10620-008-0354-3
- PMID
- 18618259
- ISSN
- 0163-2116
- eISSN
- 1573-2568
- Language
- English
- Date published
- 02/2009
- Academic Unit
- Gastroenterology and Hepatology; Internal Medicine
- Record Identifier
- 9984094405402771
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