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PubMed2002

Laparoscopic devine exclusion gastroenterostomy for the palliation of unresectable and obstructing gastric carcinoma.

The Devine exclusion gastroenterostomy is an effective procedure for the relief of gastric outlet obstruction in patients with unresectable carcinoma of the gastric antrum. We report on the successful laparoscopic application of this technique in two male patients aged 61 and 76 years with unresectable and obstructing antral gastric cancer. The operating time was 90 minutes for each patient, and the postoperative hospital stay was 3 and 4 days, respectively. There were no delays in gastric emptying and no recurrences of gastric outlet obstruction until the time of death, 3.5 and 9 months postoperatively, respectively. The laparoscopic approach to a Devine exclusion gastroenterostomy is a safe and effective minimally invasive approach to the palliation of unresectable obstructing gastric carcinoma.

Adenocarcinoma↗
PubMed1981

Shrinkage of the gastric antrum following gastroenterostomy.

Radiological and endoscopic shrinkage of the antrum of the stomach may occur in the elderly and following gastroenterostomy. We describe this in 18 subjects, of whom 17 had a gastroenterostomy with or without vagotomy. Shrinkage can appear within two years of operation and is usually associated with a well-functioning stoma. Reflux biliary gastritis occurred in almost all and in nine out of ten tested the acid secretion in response to pentagastrin was virtually nil. Dyspepsia and bile vomiting were frequent indications for endoscopy. No patient had jejunal ulceration. In the majority radiological interpretation was correct.

Adult↗
PubMed2001

Combined laparoscopic/endoscopic anvil placement for the performance of the gastroenterostomy.

BACKGROUND: We developed the laparoscopic gastric bypass in 1993 and first reported the technique and results in 1994. The technique for the gastroenterostomy was derived from the method used in the percutaneous endoscopic gastrostomy tube placement. Some have questioned the safety of this technique, and alternatives have been proposed. METHOD: Prospectively, we have followed and recorded the results of our laparoscopic patients. To date we have performed over 1,400 laparoscopic gastric bypass operations using the same technique of anvil placement: pulling the anvil down from the mouth to the stomach pouch with a percutaneously placed wire. All patients underwent upper GI endoscopy following the anvil placement, and a water-soluble upper GI series was obtained on the first postoperative day. RESULTS: There have been no esophageal injuries in the first 1400 patients on whom this technique was done. CONCLUSION: The percutaneous pull-wire technique is a safe and effective method to place the 21-mm circular stapler anvil for the performance of a laparoscopic gastroenterostomy.

Gastroenterostomy↗
PubMedDate not supplied

Laparoscopic exclusion gastroenterostomy for palliation of gastric outlet obstruction secondary to recurrent cholangiocarcinoma.

The Devine exclusion gastroenterostomy is recommended as a palliative procedure for unresectable gastric carcinoma, and avoids the problem of delayed gastric emptying. It is conventionally performed by a laparotomy. We report the successful laparoscopic application of this technique in a patient with gastric outlet obstruction secondary to recurrence of a previously resected hilar cholangiocarcinoma. A 38-year-old gentleman who had undergone a left hepatectomy with caudate lobectomy, excision of extrahepatic biliary tree, D2 regional lymphadenectomy and Roux-en-Y right hepaticojejunostomy presented 6 months later with symptoms of gastric outlet obstruction. Computed tomography revealed a tumor mass in the region of the gastric antrum. Attempted endoscopic treatment with a metal stent was unsuccessful. He underwent a laparoscopic exclusion gastroenterostomy. The operative time was 200 minutes. Postoperative recovery was uncomplicated. There was no delay in gastric emptying and no recurrence of gastric outlet obstruction until the time of death 41 days later. Laparoscopic exclusion gastrojejunostomy is a feasible option for the palliation of gastric outlet obstruction caused by recurrent cholangiocarcinoma.

Adult↗
PubMed1977

Double gastroenterostomy tube in gastric surgery.

This report describes a new double gastroenterostomy tube. It has been used in patients where delayed oral feedings are anticipated, ie, a perforated duodenal ulcer, suture-plicated, with stenosis of the duodenum; a duodenal ulcer with outlet obstruction treated with vagotomy and gastroenterostomy; and patients with chronic lung disease undergoing gastric surgery and requiring postoperative respiratory assistance. Its use has proved to be beneficial, and it is cheap and allows early enteric feeding.

Enteral Nutrition↗
PubMed1994

Cholelithiasis and bile acid absorption after truncal vagotomy and gastroenterostomy.

Gallbladder disease in the form of gallstones demonstrated by ultrasonography or previous cholecystectomy was found in 15 of 26 women of median age 69 (range 52-82) years who had had truncal vagotomy and gastroenterostomy performed a median of 27 (range 11-30) years previously, compared with eight of 31 healthy age- and sex-matched controls drawn from the community (P < 0.02). Bile acid malabsorption identified by retention of 23-selena, 25-homotaurocholate (75SeHCAT) occurred in only two of the 26 patients after vagotomy and there was no relationship between retention and the presence or absence of gallbladder disease. The serum concentration of 7 alpha-hydroxycholestenone, an indicator of bile acid turnover, was significantly lower in patients with gallbladder disease after vagotomy than in controls (mean(s.e.m.) 19.1(3.7) versus 31.4(4.4) ng/ml, P < 0.05). Bile acid malabsorption does not play a significant role in the pathogenesis of gallstones after vagotomy but decreased bile acid synthesis may be important. There is no correlation between retention of 75SeHCAT and 7 alpha-hydroxycholestenone levels in patients after vagotomy, indicating that bile acid synthesis and absorption are uncoupled in this situation.

Absorption↗
PubMed1992

CT guidance for percutaneous gastrostomy and gastroenterostomy.

The authors describe the value of computed tomographic (CT) guidance for percutaneous gastrostomy (PG) or gastroenterostomy (PGE) in 22 patients with anatomic or pathologic difficulties precluding fluoroscopic guidance. Indications for PG or PGE were decompression for gastrointestinal obstruction (n = 15) or for feeding (n = 7). Thirteen patients previously underwent an unsuccessful attempt at or had been rejected as unsuitable for percutaneous endoscopic gastrostomy. CT guidance was selected because of inability to pass a nasogastric tube due to esophageal obstruction (n = 4), inability to tolerate gastric distention (n = 1), abnormal morphology in or around the stomach (n = 16), or simultaneous performance of a PG in one patient who was undergoing emergency CT-guided abscess drainage. Catheters were placed successfully in all 22 patients. No major complications occurred. CT is valuable for PG or PGE when anatomic or pathologic problems make fluoroscopic or endoscopic puncture unsafe or impossible.

Adult↗
PubMed1997

Percutaneous endoscopic gastroenterostomy and jejunal extension for gastric stasis in pancreatic carcinoma.

Gastric stasis in pancreatic cancer without mechanical obstruction is distressing and difficult to manage. We describe two patients who were treated by percutaneous endoscopic gastroenterostomy (PEG) combined with a jejunal extension. Both patients had pancreatic cancer and gastric stasis, with recurrent vomiting and no evidence of distal duodenal obstruction. They were unresponsive to high-dose prokinetic agents. In both cases a Bower-PEG feeding tube with jejunal extension was inserted endoscopically, with clinical improvement. The technique has the advantages of permitting enteral feeding and allowing aspiration of upper gastrointestinal secretions between feeds, which produces symptomatic relief from nausea and vomiting. This manoeuvre can produce effective palliation, perhaps following the patient to be managed at home during the terminal phase of their illness.

Aged↗
PubMed2003

Laparoscopic gastric bypass for morbid obesity with linear gastroenterostomy.

BACKGROUND: Laparoscopic gastric bypass (LGBP) is a well-established procedure for the surgical management of morbid obesity. Most surgeons create the gastroenteral anastomosis by using the circular EEA stapler. We describe an alternative laparoscopic anastomotic technique using the EndoGIA linear stapling device. METHODS: The stomach was proximally transected with a linear stapler (45 mm, Endo-GIA) to create a 15 to 20 ml pouch. Next, an antecolic Roux-en-Y gastroenterostomy was performed, using the 45 mm Endo-GIA. The proximal loop of the intestine was then separated from the anastomotic site by the Endo-GIA. Finally, the Endo-GIA was used for the intraabdominal creation of a side-to-side enteroenterostomy. RESULTS: Between June and August 2001, 5 patients with mean BMI 56.7 kg/m(2)+/-7.3 underwent LGBP. All patients were seen 6 months post-surgery. Operating time was 7.5 and 6.5 hours for the first 2 operations, but was under 4.5 h for the next 3 cases. 1 patient suffered from perioperative hypoxia leading to long-term artificial respiration. 6 weeks after surgery, 1 patient developed obstruction due to torsion of the enteroenterostomy and required open revision. The 3 remaining patients made an uneventful recovery. All patients lost considerable weight (mean 36.5 kg; [range 32 to 45] after 6 months). No stenosis or anastomotic leakage was noted. CONCLUSIONS: A linear stapled anastomosis is an alternative to the use of the circular stapler.

Adult↗
PubMed1986

Percutaneous gastrostomy and gastroenterostomy: 1. Techniques derived from laboratory evaluation.

Various techniques, guidance systems, instruments, and the postmortem effects of percutaneous gastrostomy (PG) and percutaneous gastroenterostomy (PGE) were evaluated in 30 laboratory animals and five human cadavers. Methods to distend the stomach included air, fluid, intragastric balloon, and percutaneous needle inflation; a variety of trocar systems and catheters inserted by Seldinger technique (including those adapted from other uses and several designed specifically) were assessed. Fluoroscopy was the preferred guidance system, though sonography proved valuable (liver position, depth calculation to the stomach, localization of vessels to avoid), and the entire PG procedure was performed under sonographic guidance in four animals. Although the procedure was safe in most cases, several major complications did occur: laceration of a low-lying liver with exsanguination, malpositioned catheters in the lesser sac and adjacent to the spleen, and violation of the backwall of the stomach with laceration of celiac and splenic vessels. The animals and cadavers underwent autopsy. Autopsy revealed that firm gastrocutaneous tracts were formed by 7 days. There were few instances of wound infection, intraperitoneal fluid leakage, or evidence of trauma to the stomach when the catheters were well seated. Injury to the inferior epigastric artery is a potential hazard, and in cadaver dissections was located between the middle third and outer margin of the rectus abdominis muscle. Laboratory experience has been, and continues to be, an important means to improve and use new techniques for PG and PGE.

Animals↗
PubMed1986

Percutaneous gastrostomy and gastroenterostomy: 2. Clinical experience.

This report describes the authors' initial experience with percutaneous gastrostomy (PG) and gastroenterostomy (PGE) in 40 patients. Indications for PG and PGE included alimentation (35 patients) and small bowel decompression (five). Seldinger technique with air distension of the stomach via a nasogastric tube (20 patients) is a simple method to insert small (7-9 French) and firm catheters; tube exchanges for larger and softer catheters often are necessary by this method (23 procedures in 17 patients). Coaxial trocar technique (19 patients) permits initial insertion of softer and often larger catheters (9-14 French feeding tubes), which are less likely to clog or require exchange; the intragastric balloon support method facilitates trocar insertion. Now preferred is a system that uses 18-gauge needle puncture and allows coaxial insertion of a final soft feeding tube at the initial procedure. Small bowel catheter positioning (PGE) (31 patients) was more common than gastrostomy alone (8 patients); "downhill puncture" toward the gastric antrum assists direct guide-wire cannulation of the duodenum via the gastric puncture (12 patients). Five complications occurred; two were major and included catheter dislodgement in one patient. Another patient, who had a pharyngeal tumor, suffered profound respiratory difficulty from premedication and nasogastric tube malposition; patients with head and neck tumors present particular problems with nasogastric tube passage and airway monitoring. Inability to pass a nasogastric tube does not preclude PG and PGE, as direct puncture of the stomach is feasible.

Adult↗
PubMed1990

Fluoroscopically guided percutaneous gastrostomy and gastroenterostomy: analysis of 158 consecutive cases.

We reviewed our experience with 158 consecutive patients who underwent either percutaneous gastrostomy or percutaneous gastroenterostomy during a 2-year period. The catheters used included Foley catheters (36), Cope-type gastric catheters (86), or Carey-Alzate-Coons gastrojejunostomy catheters (36). Gastrojejunostomy tubes were placed in patients with gastroesophageal reflux or aspiration, gastric atony, or partial gastric obstruction. Ninety percent of the tubes were placed for feeding purposes. The technical success rate was 100%. Thirty-day follow-up was obtained in 89%. Thirty-day mortality was 26%, reflecting the substantial number of debilitated patients. No deaths were directly related to tube placement. Major morbidity was 6% and included hemorrhage, peritonitis, tube migration, and sepsis. Minor morbidity was 12%. There was no difference in 30-day mortality or feeding tolerance between the tube types (p less than .05). Patients with Foley catheters had more complications necessitating surgical intervention and an increased incidence of tube changes required within 30 days. These were the only statistically significant differences between the tubes (p less than .05). Our results show that percutaneous gastrostomy is a safe and effective means of gastroenteric feeding or decompression. Because of the fewer complications and ease of insertion, the Cope type of gastrostomy tube has become our preferred catheter for percutaneous feeding or decompression.

Aged↗
PubMed1975

[Surgical treatment of peptic ulcer after gastroenterostomy].

Based on a comparison of the immediate and late results of treatment in patients with peptic ulcers following gastroenterostomy by means of gastric resection (24 patients) and by vagotomy, it is concluded that vagotomy in most cases results in a complete cure of patients, thus this procedure is felt to be more advantageous than gastric resection due to its technical feasibility and small operative risk.

Follow-Up Studies↗
PubMedDate not supplied

Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial.

BACKGROUND: Gastroenterostomy was the palliative treatment of choice in patients with malignant unresectable gastric outlet obstruction. Palliative endoscopic treatment of malignant gastric outlet obstruction with endoluminal self-expanding metallic stents is nowadays a well-established procedure. PATIENTS AND METHODS: Eighteen patients referred for treatment with diagnosis of malignant strictures of the antro-pyloric tract presenting at an advanced unresectable stage. The patients were randomly assigned into two treatment groups (endoscopic vs. surgery) according to random-number tables. The length of procedure, morbidity and mortality rate, restoration of oral intake and gastric emptying at 8, 15 days and 3 months from treatment and hospital stay were assessed. RESULTS: Endoscopic group: The median length of procedure was 40 minutes. No death and one minor complication (11.1%) was reported. Mean time for oral intake was 2.1 days. Gastric emptying was satisfactory in 88.9% after 8 days and in 100% of patients after 15 days and 3 months. The median hospital stay was 3.1 days. Surgery group: The median length of the operation was 93 minutes. No mortality was reported. One patient (11.1%) developed anastomotic bleeding which required relaparotomy. Mean time for oral intake was 6.3 days. Gastric emptying was satisfactory in 66.7% of patients after 8 days, in 88.9% after 15 days and in 100% after 3 months. The median hospital stay was 10 days. CONCLUSION: There were no statistically significant differences between the 2 groups even with respect to morbidity, mortality, delayed gastric emptying and clinical outcomes at 3-month follow-up. Endoscopic stenting was significantly more effective with respect to operative time, restoration of oral intake and median hospitalization. Our results would suggest that endoscopically placed metal stents offer an effective alternative to surgical palliation in patients with unresectable malignant strictures.

Aged↗
PubMed1987

Vagotomy and gastroenterostomy for stenosing duodenal ulcer.

Vagotomy and gastroenterostomy (V-GE) was performed in 41 patients with chronic stenosing duodenal ulcer and gastric retention in the years 1965-84. There was no mortality and no severe complication occurred. One patient was reoperated for dysfunction of an antecolic stoma. After a follow-up of 1-16 (mean 8) years 30 patients were interviewed and gastroscopy was performed in 21. One recurrence of ulcer was found at endoscopy. Visick classification gave the following overall results: grade I 40%, grade II 13%, grade III 30% and grade IV 17%. One case of gastric carcinoma was found five years after operation. It was concluded that V-GE is a simple and safe method and will give satisfactory early and long-term results.

Adult↗
PubMed1986

Gastroenterostomy for treatment of gastroduodenal ulcer disease in 14 foals.

Gastroenterostomy was performed in 14 foals to treat gastric outflow obstruction caused by advanced gastroduodenal ulcer disease. The onset of excessive salivation and teeth grinding, without response to medical treatment, combined with endoscopic and radiographic evidence of gastric outflow obstruction, were indications for surgical intervention. Successful outcome in 5 foals was attributed to early diagnosis, patient stabilization, early surgical correction, and postoperative management including antibiotics and antiulcer medication.

Animals↗
PubMed1984

[Roentgen findings in gastroenterostomy].

Gastroenterostomy is a palliative operation for drainage. It can be represented by retrocolic and antecolic, isoperistaltic and anisoperistaltic, laterolateral and Y-Roux anastomosis. Impressions by the colic ligament are normal findings. pathological findings are anastomosis - obstruction, high position, ulcer, blind loops, gastroileostomy, volvulus of the anastomosed loop, herniation, invagination, and changes in the underlying disease.

Gastroenterostomy↗
PubMed1993

[Gastroenterostomy "par principe" or "de nécessité" in palliative therapy of pancreatic cancer?].

There has been a controversy for years concerning the value of the prophylactic gastroenterostomy (GE) in patients suffering from irresectable pancreatic cancer. A retrospective analysis of the patients undergoing palliative bypass-operations for pancreatic cancer at Zurich University Hospital between 1982 and 1990 revealed 53 patients (28 male, 25 female) with an average age of 68 years. Twenty-one patients received a double bypass, 18 received a hepaticojejunostomy, 12 a primary and 2 a secondary GE. Mortality and morbidity for double bypass were 14% and 33%, for hepaticojejunostomy 5% and 28% and for primary GE 25% and 50%. Secondary GE was associated with a mortality and morbidity of 1 of 2 cases. Two patients received a secondary GE and two more showed signs of duodenal obstruction amounting to 20% incidence for secondary duodenal obstruction. Delayed gastric emptying was observed in only 2 patients with primary GE. These data suggest the use of a prophylactic double bypass.

Aged↗