What is a gastrojejunostomy (GJ), also known as a gastric bypass?

From the Guidelines

A gastrojejunostomy is a surgical procedure that creates a connection between the stomach and the jejunum, bypassing the duodenum, and is commonly performed to treat conditions that obstruct the normal passage of food, such as peptic ulcers, stomach cancer, or duodenal obstruction, with a laparoscopic approach favored over an open approach due to lower blood loss and shorter hospital stay 1.

Key Points

• Gastrojejunostomy is a surgical procedure that creates a connection between the stomach and the jejunum, allowing food to move directly from the stomach into the jejunum.
• The procedure is commonly performed to treat conditions that obstruct the normal passage of food, such as peptic ulcers, stomach cancer, or duodenal obstruction.
• A laparoscopic approach is favored over an open approach due to lower blood loss and shorter hospital stay, as shown in recent studies 1.
• The SUSTENT study found that surgical gastrojejunostomy provided better long-term relief compared to enteral stent placement, although it was associated with higher rates of delayed gastric emptying 1.

Considerations

• Patients with life expectancy more than 2 months who are surgically fit should undergo surgical gastrojejunostomy, whereas those with less should undergo enteral stent placement 1.
• Poor nutritional status, ascites, and poor functional status are independent predictors of clinical failure of a surgical gastrojejunostomy 1.
• The procedure works by creating an alternative pathway for food, bypassing blockages and allowing for proper nutrition and digestion despite underlying gastrointestinal pathology.

Recommendations

• For patients with gastric outlet obstruction who are undergoing surgical gastrojejunostomy, a laparoscopic approach is favored over an open approach due to lower blood loss and shorter hospital stay 1.
• Patients should be carefully selected for surgical gastrojejunostomy based on their life expectancy, surgical fitness, and overall health status 1.

From the Research

Definition of Gastrojejunostomy

• Gastrojejunostomy is a surgical procedure that involves creating a connection between the stomach and the jejunum, which is a part of the small intestine 2.
• This procedure is often performed to allow for nutrition to be administered directly into the jejunum, bypassing the stomach.

Techniques and Indications

• There are several techniques used for gastrojejunostomy, including open gastrojejunostomy, which is one of the methods mentioned in the study 2.
• The principal indication for a gastrojejunostomy is as an additional procedure during major surgery of the upper digestive tract, where nutrition can be infused at the level of the jejunum 2.
• It is also used in patients who require prolonged nutrition support, such as those with neurologic or congenital illnesses, geriatric patients, or patients with tumors of the head and neck 2.

Complications

• The complications of gastrojejunostomy can be mechanical, infectious, gastrointestinal, or metabolic 2.
• The rate of technical complications for open gastrojejunostomy is reported to be around 2% 2.
• Common complications include tube dislocation, obstruction or migration of the tube, cutaneous or intraabdominal abscesses, enterocutaneous fistulas, and intestinal ischemia 2.