Elias A. Chamely, MD, Bryan Hoang, Nadim S. Jafri, MD, MSc, Melissa M. Felinski, DO, Kulvinder S. Bajwa, MD, Peter A. Walker, MD, Jaideep Barge, MD, Erik B. Wilson, MD, Putao Cen, MD, Shinil K. Shah, DO
Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX. (Drs. Chamely, Hoang, Felinski, Bajwa, Walker, Wilson, and Shah)
Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX. (Dr. Jafri)
Radiology Partners, Houston, TX. (Dr. Barge)
Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, TX. (Dr. Cen)
Michael E DeBakey Institute of Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX. (Dr. Shah)
Background: Gastric outlet obstruction secondary to foregut gastrointestinal malignancies can be managed with a variety of medical, endoscopic, and surgical options. Laparoscopic gastrojejunostomy is an option for those patients who are able to tolerate an operation as a long-term palliative option. This operation may be associated with some significant postoperative technical and nontechnical complications, including delayed gastric emptying. This paper describes an incisionless, endoscopic option that we propose can be used to salvage a functionally obstructed gastrojejunostomy.
Case Description: A 57-year old male patient had a history of pancreatic adenocarcinoma causing gastric outlet obstruction and underwent a previously created surgical gastrojejunostomy at an outside hospital. His procedure was complicated by anastomotic leak and essentially persistent obstructive symptoms secondary to delayed gastric emptying. Though his anastomosis was demonstrably patent, these symptoms were thought to be secondary to a functional obstruction at the gastrojejunostomy. After repeated workups and many failed attempts to treat these symptoms, he ultimately underwent endoscopic placement of an uncovered colonic stent into the efferent limb of his gastrojejunostomy. This allowed for preferential drainage of gastric contents down the efferent limb, and improvement of his delayed gastric emptying.
Conclusions: In a select group of patients with advanced foregut malignancy, and with high re-operative risks, salvage endoscopic stenting may be useful in the palliation of symptoms from a functionally obstructed gastrojejunostomy.
Key Words: Gastric outlet obstruction, Gastrojejunostomy, Delayed gastric emptying, Endoscopy, Stent.