RSS-Feed abonnieren
DOI: 10.1055/s-0031-1291447
Endoscopic vs. laparoscopic gastrojejunostomy for duodenal obstruction: a randomized study in a porcine model
Publikationsverlauf
submitted 16. November 2010
accepted after revision 30. August 2011
Publikationsdatum:
22. November 2011 (online)
![](https://www.thieme-connect.de/media/endoscopy/201202/lookinside/thumbnails/10.1055-s-0031-1291447-1.jpg)
Background and study aims: Open or laparoscopic gastrojejunostomy is an established treatment for malignant duodenal obstruction but may be associated with significant morbidity and mortality. The purpose of this study was to develop a model for an entirely endoscopic gastrojejunostomy to treat duodenal obstruction, and to compare this with the laparoscopic technique.
Methods: During the first part of the study the endoscopic technique was developed and tested in porcine nonsurvival and survival experiments (n = 12). During the second part of the study (n = 10), endoscopic gastrojejunostomy for duodenal occlusion was compared with laparoscopic gastrojejunostomy in a survival randomized controlled trial (RCT). For both groups duodenal occlusion was achieved by the laparoscopic approach.
Results: In the RCT, the median times for laparoscopic vs. endoscopic gastrojejunostomy were 70 minutes (interquartile range [IQR] 65 – 75) vs. 210 minutes (IQR 197 – 220; P = 0.01). There was a trend toward increased anastomotic diameter at necropsy in the laparoscopic group (2 cm, IQR 2 – 3) compared to the endoscopic group (1.8 cm, IQR 1.6 – 1.8; P = 0.06). One animal in the endoscopic group died secondarily to bowel ischemia from volvulus of the jejunal loop. One animal in the laparoscopic group was prematurely sacrificed due to extensive pulmonary congestion and edema. All anastomoses were intact and patent.
Conclusions: Purely endoscopic gastrojejunostomy using the developed technique and devices is feasible and can result in adequate relief of duodenal obstruction. Endoscopic anastomoses tend to be smaller than laparoscopic anastomoses, with the procedures being more time-consuming and associated with higher complication rates.
-
References
- 1 Jeurnink SM, Steyerberg EW, van Hooft JE et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 2010; 71: 490-499
- 2 van Hooft JE, van Montfoort ML, Jeurnink SM et al. Safety and efficacy of a new non-foreshortening nitinol stent in malignant gastric outlet obstruction (DUONITI study): a prospective, multicenter study. Endoscopy 2011; 43: 671-675
- 3 Bessoud B, de Baere T, Denys A et al. Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 2005; 16: 247-253
- 4 Holt AP, Patel M, Ahmed MM. Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?. Gastrointest Endosc 2004; 60: 1010-1017
- 5 Lopera JE, Brazzini A, Gonzales A et al. Gastroduodenal stent placement: current status. Radiographics 2004; 24: 1561-1573
- 6 Maetani I, Tada T, Ukita T et al. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 2004; 36: 73-78
- 7 Park KB, Do YS, Kang WK et al. Malignant obstruction of gastric outlet and duodenum: palliation with flexible covered metallic stents. Radiology 2001; 219: 679-683
- 8 Kalloo AN, Singh VK, Jagannath SB et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 2004; 60: 114-117
- 9 Kantsevoy SV, Adler DG, Chand B et al. Natural orifice translumenal endoscopic surgery. Gastrointest Endosc 2008; 68: 617-620
- 10 Kantsevoy SV, Jagannath SB, Niiyama H et al. Endoscopic gastrojejunostomy with survival in a porcine model. Gastrointest Endosc 2005; 62: 287-292
- 11 Chiu PWY, Wai Ng EK, Teoh AYB et al. Transgastric endoluminal gastrojejunostomy: technical development from bench to animal study (with video). Gastrointest Endosc 2010; 71: 390-393
- 12 Bergström M, Ikeda K, Swain P et al. Transgastric anastomosis by using flexible endoscopy in a porcine model (with video). Gastrointest Endosc 2006; 63: 307-312
- 13 Kantsevoy SV, Jagannath SB, Niiyama H et al. A novel safe approach to the peritoneal cavity for per-oral transgastric endoscopic procedures. Gastrointest Endosc 2007; 65: 497-500
- 14 Razzaq R, Laasch HU, England R et al. Expandable metal stents for the palliation of malignant gastroduodenal obstruction. Cardiovasc Intervent Radiol 2001; 24: 313-318
- 15 Kantsevoy SV, Niiyama H, Jagannath SB et al. The endoscopic transilluminator: an endoscopic device for identification of the proximal jejunum for transgastric endoscopic gastrojejunostomy. Gastrointest Endosc 2006; 63: 1055-1058