What Is a Gastrojejunostomy Procedure?

Image shows about 10 inches of sutures on internal organs, the anastomosis (surgically created opening) from the stomach to the mid small intestine.

Gastrojejunostomy is a surgical procedure to create a direct connection (anastomosis) from the stomach to the middle part of the small intestine (jejunum), bypassing or removing the beginning part of the small intestine (duodenum).

Depending on the individual requirement, a doctor may perform one of the following types of gastrojejunostomy:

• Open surgery: The surgeon accesses the nerve with a long, midline incision and surgical tools typical for open abdominal surgeries.
• Laparoscopic surgery: The surgeon makes a single or several tiny incisions.  The surgeon then performs the procedure with tiny surgical tools  inserted through a flexible, lighted, viewing tube (laparoscope)
• Robotic laparoscopic surgery: A  robot  operates  the tiny surgical tools in the laparoscope. The surgeon uses a computer terminal to direct and control the robot.    
• Percutaneous gastrojejunostomy: A minimally invasive procedure to place a feeding tube through the stomach wall and the stomach’s interior    through the duodenum into the jejunum.
• Endoscopic gastrojejunostomy: A  recently developed procedure to place a stent in the jejunum using a flexible tube (endoscope) passed through the nose, through the upper digestive tract.

A percutaneous gastrojejunostomy may also be performed along with an endoscopy as a hybrid procedure.

A gastrojejunostomy is most often performed as a treatment for obstruction in the terminal part of the stomach (pylorus) and the duodenum (gastric outlet obstruction). It may or may not involve removal of the bypassed parts of the digestive system.

Surgical gastrojejunostomy maybe performed in a patient who

• Undergoes gastric bypass surgery for weight loss
• Undergoes removal of part of the stomach (gastrectomy) and/or the duodenum for benign or malignant obstruction
• Undergoes removal of vagus nerve (vagotomy) as a treatment for peptic ulcers
• Experiences delayed emptying of stomach contents (gastroparesis) due to a gastric surgery or diabetes

A laparoscopic gastrojejunostomy may also be performed as a palliative treatment on people with malignant conditions.

Percutaneous gastrojejunostomy is performed to provide nutrition directly to the intestines of patients who are unable to eat orally. The procedure may be performed for patients with

• nausea
• vomiting
• gastroparesis

The procedure may also be useful for patients

• during recovery from major abdominal surgeries
• as a palliative treatment for inoperable malignancies of the stomach, duodenum or the pancreas.
• A percutaneous gastrojejunostomy may be temporary or permanently in place depending on the individual’s requirements.

Endoscopic gastrojejunostomy is still a developing technique and may not be suitable for all patients. This procedure is performed in patients with less severe conditions, who are able to feed orally. It is a safer, effective and less invasive alternative to surgery. Its efficacy may be of short duration in some who may later require a surgery, however.

Gastrojejunostomy should be performed with caution in patients

• At high risk for developing leaks in the anastomosis due to
• fluid in the abdomen (ascites)
• low albumin count
• secondary malignant cancers
• With inflammation of the stomach lining (peritonitis) along with sepsis
• With swollen veins in the abdomen (gastric varices)
• With adhesions from previous abdominal surgeries