Copyright ©The Author(s) 2018.
World J Gastroenterol. May 14, 2018; 24(18): 1978-1988
Published online May 14, 2018. doi: 10.3748/wjg.v24.i18.1978
Table 1 Systematic review and meta-analysis: Stents vs gastrojejunostomy
Ref.Type of studyGJ studiesSurgeryEndoscopic stentNo differences
Minata et al[8], 2016Systematic reviewLGJ (Mehta 2006, Jeurnink 2010) OGJ (Jeurnink 2010, Fiori 2013)Lower re-intervention rateLess invasive COVERED: Higher migration UNCOVERED: Higher obstructionTechnical success Complications
Nagaraja et al[13], 2014Meta-analisisLaparoscopic GJ (Mittal 2004, Mehta 2006, Jeurnink 2007, Jeurnink 2010)Shorter LOSTechnical and clinical outcomes
Ly et al[38], 2010Systematic reviewOpen GJ (Jeurnink 2007, El-Shabrawi 2006, Mehta 2006, Espinal 2006, Mejia 2006, del Piano 2005, Maetani 2005, Fiori 2004, Mittal 2004, Maetani 2004, Johnsson 2004, Wong 2002, Yim 2001) Laparoscopic GJ (Jeurnink 2007, Mehta 2006, Mittal 2004)More major medical complicationsMore likely to tolerate an oral intake More likely to tolerate an oral diet earlier Shorter LOSSurvival 30 d-mortality Major complications
Table 2 Systematic review of laparoscopic gastrojejunostomy for gastrict obstruction due to advanced hepatobiliary cancer
Ref.nType of studyHPB EtiologyBiliary obstructionOperating timePerioperative morbidityTime to initiate intakeTime to solid foodLOSDuration of food intakeComment
All HPB Malignancy
Jeurnink et al[60], 200795Cohort: GJ (42) vs duodenal stent (53)GJ: All patients (laparoscopy: 10)GJ: 17 previous treatmentNDGJ: 4 major (hemorrhage, severe pain, cholangitis, respiratory failure); 13 minor (mild pain, wound infection, nausea and vomiting)NDGJ: 10.1 ± 4.8 dGJ: 18d (4-55)ND
Hamade et al[4], 200521Cohort: laparoscopic GJ/CJ/GJ+CJAll patients5 biliary bypass, 8 GJ+biliary bypassgastric bypass 75 min, GJ+CJ 130 min1 pneumonia, 1 central line sepsis, 1 wound abscessNDND4 d (1-14)9 patients untill deathIncludes pre-treatment, profilactic and terapeutic GJ
Denley et al[9], 200518Case series: LGJAll patientsNDND2 reconversions, 1 leak, 1 sepsis, 1 DGENDND6 (3-22)15 patients untill death
Kazanjian et al[5], 20049Case series: LGJAll patientsND116 min (75-300)1 DGE, 1 CholangitisND4 d (3-6)7 d (5-18)ND4 patient previous stent
Alam et al[61], 20038Case series: LGJAll patientsND135 minPneumonia (1)ND4 (2-7)7 (5-13)7 patients untill death
Kuriansky et al[62], 200012Case series: LGJ+biliary bypassAll patients12 CCJ89.16 min (35-150)2 wound infection, 1 pneumonia, 2 DGE, 1 reintervention (bleeding)NDND6.4 (5-17)All patients untill death
Casaccia et al[63], 19996Case series: LGJAll patients4 ES. 2 Laparoscopic CCJ82 min (60-135)1 Bleeding (transfusion)NDND4.5 (4-6)ND
Casaccia et al[64], 19985Case series: LGJAll patients4 ES. 1 laparoscopic CCJND1 Bleeding (transfusion)NDND4 (4-6)ND
Rhodes et al[65], 199516Case series: laparoscopic CCJ ± GJ (5GJ, 3 both, 9CCJ)All patientsND75 min1 DGE, 1 ictusNDND4 d (3-33)NDResults of the entire data series
Wilson et al[57], 19922Case series: LGJAll patientsND120 minNone2d3 d, 4 d4-5 d1 patient untill death
Mixed malignancies
Zhang et al[66], 201128Case series: LGJ for benign/malignant disease7 HPB malignancyND170 min2 reinterventions (anastomotic leak, trocar site hemorrhage), 2 bleeding controlled by endoscopy, 1 ileus, 5 DGE3d5 d8 d (2-83)NDResults of the entire data series
Guzman et al[3], 200920Cohort: LGJ AND OGJLaparoscopy: 8 HPB malignancyND116 min2 DGEND7 d8 dND
Navarra et al[67], 200624RCT: 12 LGJ vs 12 OGJLaparoscopy: 5 HPB malignancyND150 minNoneND4.08 d11 dND
Mehta et al[39], 200627RCT: 14 LGJ vs 13 SEMSND6 patients (ES, PD)ND2 bleeding, 1 wound infection, 1 pneumonia, 3 DGE. 3 mortality (sepsis, pneumonia, carcinomatosis)NDND11.4 DND
Al-Rashedy et al[68], 200526Cohort: LGJ and OGJLaparoscopy: 7 HPB malignancyNDND2 (13.3%)NDND3 (3-8)ND
Khan et al[69], 200519Case series: laparoscopic CCJ ± GJ (16 GJ, 1 CCJ, 2 both)7 HPB malignancy2 CCJ164 min single bypass, 245 min double bypassND3dNDNDND
Mittal et al[37], 200456Cohort: 16 OGJ, 14 LGJ, 16 ES.Laparoscopy: 9 HPB malignancyNone patientND4 pneumonia, 1 ileus, 1 wound infectionND5 d (4-8)13.5 d (6-36) (after procedure 7d)ND
Bergamaschi et al[70], 200255Case/control: antiperistaltic vs isoperistaltic LGJAP-LGJ: 29 HPB malignancy, IP-LGJ 14 HPB malignancyND100min (AP) vs 99min (IP)14 (II: 1, III: 9, IV: 3)ND5.1d (AP) vs 5.3 d (IP)8.4 d (AP) vs 8.1 d (IP)ND
Bergamaschi et al[71],199822Case /control: OGJ (prophylactic and GOO treatment) vs LGJ (GOO treatment)Laparoscopy: 9 HPB malignancy1 ES, 3 PD94 minPneumonia (1), SSI (1), delayed gastric emptying (1)ND8.4 (media)18.4 (media)ND
Brune et al[15], 199716Case series: LGJ13 HPB malignancyES/PD126 min (70-210)1 reintervention (hemorrhage), 3 delayed gastric emptyingNDND4.7 (2-8)16 patients untill death
Nagy et al[72], 199510Case series: LGJ9 HPB malignancy8 ES/1 PD/ 2 simultaneous CJND2 reconversions, 1 CCF, 1 pneumonia, 1 CD infectionND10 d (4-15)NDAll patients untill death
Table 3 Systematic review of laparoscopic gastrojejunostomy for gastrict obstruction due to advanced hepatobiliary cancer: Surgical technique
All HPB malignancy
Jeurnink et al[60], 2007NDAntecolicCompletely stapler
Hamade et al[4], 2005IPAntecolicStapler + manual suture
Denley et al[9], 2005IPAntecolicStapler + manual suture
Kazanjian et al[5], 2004NDAntecolicCompletely stapler
Alam et al[61], 2003IPNDCompletely stapler
Kuriansky et al[62], 2000NDRetrocolicCompletely stapler
Casaccia et al[63], 1999NDAntecolicCompletely stapler/stapler+ manual suture
Casaccia et al[64], 1998NDAntecolicCompletely stapler/stapler+ manual suture
Rhodes et al[65], 1995NDNDStapler + manual suture
Wilson et al[57], 1992NDAntecolicStapler + manual suture
Mixed malignancies
Zhang et al[66], 2011NDAntecolic (majority)Stapler + manual suture
Guzman et al[3], 2009NDNDStapler + manual suture
Navarra et al[67], 2006IPAntecolicStapler + manual suture
Mehta et al[39], 2006NDAntecolicStapler + manual suture
Al-Rashedy et al[68], 2005NDAntecolicHand-sutured or stapler
Khan et al[69], 2005NDAntecolicStapler + manual suture
Mittal et al[37], 2004NDNDND
Bergamaschi et al[70], 200229 AP vs 14 IPAntecolic17 completely stapled/38 stapler+ manual suture
Bergamaschi et al[71],1998NDND7 completely stapled/2 stapler+ manual suture
Brune et al[15], 1997IPAntecolicStapler + manual suture
Nagy et al[72], 1995NDAntecolicStapler + manual suture
Table 4 Personal serie of laparoscopic gastrojejunostomy
Age/sexBiliary obstructionSurgical techniqueClinical successTime to initiate intakeSurgery-discharge (d)90-d morbidityDuration of food intakeSurvival (d)
87/FNoIP antecolic, stapler + manual sutureYes412CD infectionUntil death402
76/MBiliary stentIP antecolic, stapler + manual sutureYes312NoUntil death228
91/FNoIP antecolic, stapler + manual sutureYes15NoUntil death278
78/FNoIP antecolic, stapler + manual sutureYes310Readmission: Sepsis due to hepatic abscess (death)7878
68/FBiliary stentIP antecolic, stapler + manual sutureYes312Readmission: Intestinal obstruction due to carcinomatosis (death)8282
76/MBiliary stentIP antecolic, stapler + manual sutureYes313Catheter-related bacteriemia. Readmission: Biliary stent due to jaundice.Until death220
76/FNoIP antecolic, stapler + manual sutureYes35NoUntil deathND
Table 5 Technical options for gastric outlet obstruction: advantages and disadvantages
Open GJBypass of tumorMost invasive procedure
Established surgical procedureLonger LOS
Lower re-intervention rateNutritional status
Good long-term resultsCritically ill patients
Laparoscopic GJBypass of tumorInvasive procedure
Lower re-intervention rateLonger LOS
Established surgical procedureNutritional status
Less invasive than open GJCritically ill patients
Good long-term results
Endoscopic enteral stentShort procedure timeStent migration
Established endoscopic procedurePatency
Broad indication regardless patient condition
Short LOS
Good short-term results
EUS-GJBypass of tumorSpecial device
Short procedure timeNon-establish endoscopic procedure
Short LOSSerious adverse events
Less invasive