Gastrojejunostomy (EUS-Guided Stomach-to-Bowel Bypass)

When the outlet of the stomach is blocked, nothing that is eaten can pass into the bowel. The patient vomits, cannot eat, and loses weight quickly. This is called gastric outlet obstruction, and it most often develops when cancers of the pancreas and stomach press on the outlet.

Rather than opening the blockage, gastrojejunostomy makes a route around it: a wide stent is placed with an endoscope between the stomach and a loop of small bowel, creating a new passage. Food goes straight from that new opening into the bowel.

When is it needed?

• Gastric outlet obstruction caused by a tumour
• Patients unfit for surgery, or at high surgical risk
• Cases where a stent in the duodenum is unsuitable or has not been enough

Why this rather than an operation?

There is a surgical way to the same end (surgical gastroenterostomy). But most of these patients have advanced cancer and could not stand a major operation.

Placing a stent in the duodenum is also an option, but because that stent sits inside the tumour it can block in time as the tumour grows into it. In gastrojejunostomy the stent is placed away from the blockage, so it stays open for longer.

Published series report technical success rates of 90–95%.

Consent form

The clinic’s consent form will be signed.

How is it done?

An endoscope with an ultrasound probe at its tip is passed into the stomach. Ultrasound is used to find a suitable loop of small bowel lying close to the stomach wall — this is the hardest step of the procedure, because the target is a mobile loop of bowel.

A puncture is made from the stomach wall into that loop, and a lumen-apposing metal stent (LAMS) is placed between the two organs. The stent is dumbbell-shaped; the wide flanges at each end hold the walls of the stomach and bowel against one another and form a leak-proof opening.

Afterwards

Once it has been confirmed that there is no leak, liquids are generally started the next day and normal eating is resumed by degrees. Being able to eat again is the most marked change in quality of life for these patients.

What are the risks?

• The stent opening in the wrong position, with leakage into the abdomen
• Bleeding
• The stent moving out of place
• Infection

This is an advanced procedure and needs to be done in an experienced centre.