Partial stomach-partitioning gastrojejunostomy for gastric outlet obstruction: A cohort study based on consecutive case series from a single center

Biying Huang; Berit Sunde; Andrianos Tsekrekos; Masaru Hayami; Ioannis Rouvelas; Magnus Nilsson; Mats Lindblad; Fredrik Klevebro

doi:10.1016/j.asjsur.2021.05.047

Partial stomach-partitioning gastrojejunostomy for gastric outlet obstruction: A cohort study based on consecutive case series from a single center

Asian J Surg. 2022 Jan;45(1):326-331. doi: 10.1016/j.asjsur.2021.05.047. Epub 2021 Jun 20.

Authors

Biying Huang¹, Berit Sunde², Andrianos Tsekrekos³, Masaru Hayami⁴, Ioannis Rouvelas⁵, Magnus Nilsson⁶, Mats Lindblad⁷, Fredrik Klevebro⁸

Affiliations

¹ Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden. Electronic address: Biying.huang93@gmail.com.
² Department of Upper Abdominal Diseases, Karolinska University Hospital; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Berit.sunde@ki.se.
³ Department of Upper Abdominal Diseases, Karolinska University Hospital; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Andrianos.tsekrekos@ki.se.
⁴ Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden. Electronic address: Masaru0883@hotmail.com.
⁵ Department of Upper Abdominal Diseases, Karolinska University Hospital; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Ioannis.rouvelas@ki.se.
⁶ Department of Upper Abdominal Diseases, Karolinska University Hospital; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Magnus.nilsson@ki.se.
⁷ Department of Upper Abdominal Diseases, Karolinska University Hospital; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: Mats.lindblad@ki.se.
⁸ Department of Upper Abdominal Diseases, Karolinska University Hospital; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden. Electronic address: fredrik.klevebro@ki.se.

PMID: 34158203
DOI: 10.1016/j.asjsur.2021.05.047

Abstract

Background/objective: Gastric outlet obstruction can have a large impact on quality of life for patients with upper gastrointestinal cancer or benign obstruction. Partial stomach-partitioning gastrojejunostomy has previously shown promising outcomes compared to conventional gastrojejunostomy in terms of reduced delayed gastric emptying. The objective of the current study was to present outcomes of partial stomach-partitioning gastrojejunostomy in a single high-volume center for upper gastrointestinal cancer.

Methods: A retrospective cohort study including all consecutive patients who underwent partial stomach-partitioning gastrojejunostomy from 2013 to 2020. The primary outcome was oral intake tolerance. A subgroup analysis was performed in all patients with manifest gastric outlet obstruction comparing partial stomach-partitioning gastrojejunostomy to conventional gastrojejunostomy.

Results: Partial stomach-partitioning gastrojejunostomy was performed in 32 patients and laparoscopic technique was used in 19 patients (59%). The procedure improved oral intake tolerance defined by gastric outlet obstruction scoring system by 0.63 points on average (P = 0.041). No postoperative complications related to the procedure were observed. Recurrence of gastric outlet obstruction developed in six patients (19%), four patients (13%) required endoscopic reintervention but no patient required surgical reintervention. A comparison between partial stomach-partitioning gastrojejunostomy and conventional gastrojejunostomy showed no statistically significant differences regarding postoperative nutritional status, length of hospital stay, recurrence or reintervention.

Conclusion: The results of the study show that partial stomach-partitioning gastrojejunostomy can be an effective surgical treatment for patients suffering from gastric outlet obstruction and that the procedure can be safely performed with laparoscopic technique.

Keywords: Gastric outlet obstruction; Modified Devine exclusion; Partial stomach-partitioning gastrojejunostomy; Upper gastrointestinal cancer.

MeSH terms

Cohort Studies
Gastric Bypass*
Gastric Outlet Obstruction* / etiology
Gastric Outlet Obstruction* / surgery
Gastrointestinal Neoplasms*
Humans
Palliative Care
Quality of Life
Retrospective Studies
Stomach Neoplasms* / complications
Stomach Neoplasms* / surgery
Treatment Outcome