title: Gastric Outlet Obstruction due to Gastrointestinal Amyloidosis.
abstract: A 64- year-old man with smoldering myeloma presented to the hospital for nausea, vomiting, and PO intolerance. Abdominal CT demonstrated massive gastric distention and collapsed proximal duodenum consistent with gastric outlet obstruction (GOO). Esophagogastroduodenoscopy demonstrated pyloric edema. Duodenal biopsies were consistent with AL amyloidosis. Given the concerns for bleeding risk and immediate need to start chemotherapy, surgery was deferred. Chemotherapy was initiated with a good clinical response. Our non-operative approach is novel, eliminates perioperative adverse events, allows for early initiation of chemotherapy, and can serve as a model for patients with GOO resulting from AL amyloidosis who are not surgical candidates.
authors.affiliation: Department of Internal Medicine, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX, 78234, USA. jared.a.cohen5.mil@mail.mil.
authors.forename: Jared A
authors.initials: JA
authors.lastname: Cohen
authors.affiliation: Department of Hematology and Oncology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: Jong
authors.initials: J
authors.lastname: An
authors.affiliation: Department of Hematology and Oncology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Brown
authors.affiliation: Department of Gastroenterology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Spearman
authors.affiliation: Department of Gastroenterology, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
authors.forename: Angelo
authors.initials: A
authors.lastname: Paredes
mesh_terms: D000686:Amyloidosis / Q000188:drug therapy / Q000209:etiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000188:drug therapy*; D013272:Stomach Diseases / Q000188:drug therapy / Q000209:etiology*
keywords: Amyloidosis; Chemotherapy; Gastric outlet obstruction; Multiple myeloma; Non-operative management