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At least 19 recordsLinked to original sources
PubMed1978

Treatment of severe side effects after vagotomy and gastroenterostomy by closure of gastroenterostomy without pyloroplasty.

We describe nine patients who had severe, persistent abdominal pain, vomiting, dumping, or diarrhoea several years after truncal vagotomy and gastroenterostomy had been performed for duodenal ulceration. Each patient was judged to have a bad clinical result (Visick grade 4). There was no evidence of recurrent ulceration in any of the patients, and in each the patency of the pyloric canal was confirmed radiologically or endoscopically. Each patient was treated by simply dismantling the gastroenterostomy without addition for a pyloroplasty. In one patient the surgeon suspected that a vagal trunk might have been left intact, and a revagotomy was performed by the "highly selective" technique. Postoperatively, none of the patients developed gastric retention. Symptomatic improvement occurred in eight patients, and four of them achieved perfect results (Visick grade 1). Side effects are common after vagotomy and gastroenterostomy, and are largely attributable to the presence of the gastroenterostomy stoma. Our results show that the symptoms may be alleviated by closing the gastroenterostomy, without precipitating gastric retention.

Adult↗
PubMed1991

A comparative study of gastric histopathology after partial gastrectomy between the gastroenterostomy area and gastric body.

One hundred and thirty partially gastrectomized subjects, who had been operated on for benign peptic ulcers, were studied to assess the histologic changes in the remaining gastric mucosa and its implications for gastric carcinogenesis. Endoscopic examination and multiple mucosal biopsies from the gastroenterostomy area and gastric body were compared histopathologically. Gastric carcinoma was found in two instances among these 130 patients, making a prevalence rate of 1.5% for carcinoma in the residual stomach. Chronic atrophic gastritis and pseudopyloric metaplasia were found to have developed more often in the gastroenterostomy mucosa than in the gastric body mucosa (p less than 0.001). The mean value of the gastritis score for gastroenterostomy mucosa (2.7 +/- 1.3) was statistically higher than that for the gastric body (2.1 +/- 1.0; p less than 0.001). The degree and types of histologic alteration in the gastric mucosa were also affected by the type of operation and by the postoperative duration. The mean value of the gastritis score and the frequency of pseudopyloric metaplasia, whether in the gastroenterostomy area and/or at the gastric body, were higher in Billroth II resections than in Billroth I resections. The gastritis score and the frequency of pseudopyloric metaplasia increased as the postoperative period increased. However, in the same postoperative period, the mean values of the gastritis score and the frequency of pseudopyloric metaplasia were higher in the gastroenterostomy mucosa than in the gastric body. Gastric dysplasia was more common in the gastroenterostomy area than in the gastric body. Patients who had received a Billroth II resection and those with a longer postoperative period had a higher frequency of gastric dysplasia.

Female↗
PubMed1989

[Palliative biliodigestive anastomosis in non-resectable cancer of the head of the pancreas--with or without preventive gastroenterostomy?].

In 226 patients with malignant obstructive jaundice over a 10-year period (1975-1984) 92 presented with an unresectable carcinoma of the head of the pancreas and were treated with a palliative bilioenteric diversion: in 52 cases alone, in 20 cases with a therapeutic gastroenterostomy because of early duodenal obstruction, and in 20 cases with a simultaneous prophylactic gastroenterostomy. The latter did not increase perioperative morbidity (25% vs. 50% in bilioenteric diversion alone), mortality (5% vs. 19%) nor length of hospital stay (19.9 vs. 20.6 days). Later on patients with a prophylactic gastroenterostomy showed a decreased incidence of chronic vomiting (15% vs. 42%). No secondary gastroenterostomy was performed in this group, vs. 14% (6 patients) in cases with bilioenteric diversion alone (mortality 33%). We recommend the simultaneous prophylactic gastroenterostomy which does not increase morbidity, mortality and length of hospital stay and helps avoiding a risky secondary gastroenterostomy.

Aged↗
PubMed1989

Role of gastroenterostomy in the palliative surgical treatment of pancreatic cancer.

The records of 72 consecutive patients with unresectable pancreatic cancer treated between 1974 and 1986 were evaluated to determine whether gastroenterostomy should be performed on a routine basis at initial intervention or on a therapeutic basis. Fourteen patients underwent an explorative laparotomy, 41 patients underwent biliary bypass, and 17 patients required biliary bypass and therapeutic gastroenterostomy at initial laparotomy. The mortality and morbidity rates in this last group were 18 and 59%, respectively. The most common complication was delayed gastric emptying (29%). Of the 37% of patients who required gastroenterostomy after initial biliary bypass, the mortality rate was 50% and delayed gastric emptying occurred in 57%. The mean survival after biliary bypass was 9.4 months while survival after therapeutic gastroenterostomy averaged 4.2 months. These findings suggest that gastroenterostomy should be performed on a prophylactic basis at initial intervention, unless a limited survival is expected.

Adolescent↗
PubMed1989

Delayed return of gastric emptying after gastroenterostomy.

A retrospective study of patients having gastroenterostomies was undertaken to identify predictive factors for the development of postoperative delayed return of gastric emptying (DRGE). A total of 322 consecutive patients underwent 324 gastroenterostomies; 35 experienced delayed return of gastric emptying. Regression analysis demonstrated preoperative obstruction to be the most significant factor (P less than 0.001). Vagotomy was not an independent variable. Age, sex, size of stoma, anastomotic technique, albumin and experience of the operator were not significant factors. Gastroenterostomy in the presence of 'gastric atony' was likely to produce DRGE. In all, 86 per cent of cases resolved spontaneously. Only one case of DRGE was found to have a mechanical cause. Most patients were supported by parenteral nutrition but, with a knowledge of the identified risk factors, more thought could be given to establishing a route for jejunal feeding at the time of surgery.

Adolescent↗
PubMed1977

Is reduced release of gastrin the mechanism of ulcer healing after gastroenterostomy?

Until recently in this unit gastroenterostomy was the operation of choice for patients with duodenal ulcer whose maximal acid output (MAO) is less than 30 mmol/hr. Ulceration (jejunal) has recurred in only 2.1%. Unlike partial gastrectomy, which has a peak incidence of ulcer recurrence in the first two years, the incidence of ulcer recurrence remains constant throughout the years after gastroenterostomy. In looking for the explanation of this low recurrence rate we have studied the effect of the operation upon serum gastrin responses to standardized test meals 3 weeks and 26 weeks after operation in 9 patients. Nine normal subjects acted as controls. Six months after operation the responses were significantly lowered, a fall in the serum levels of gastrin at 30, 45, 60 and 90 min after means suggesting that gastroenterostomy reduces both the gastric and intestinal phases of acid secretion. The mean integrated gastrin response (IGR) throughout the postprandial 90 min is also significantly lower 6 months after surgery. The overall mean reduction was 31.1%.

Adult↗
PubMed1985

Impact of radiotherapy on palliative gastroenterostomy in pancreatic cancer.

The previously unaddressed impact of radiotherapy and vagotomy on palliative gastroenterostomy (GE) in patients with unresectable pancreatic cancer was studied. Sixty-eight patients were retrospectively evaluated. A higher overall incidence of complications was found in the group (N = 44) undergoing irradiation as well as gastroenterostomy compared to a group undergoing gastroenterostomy alone. The increased complications were due to 16 episodes of bleeding among the irradiated patients. Rates of obstructive complications were similar for both groups (20%). Rates of bleeding were highest among patients undergoing prophylactic GE and irradiation compared to those receiving GE alone. Vagotomy in 12 patients who were irradiated did not appear to protect against bleeding. We found the irradiated prophylactic GE to provide poor palliation in patients with unresectable pancreatic cancer and recommend it not be performed if radiotherapy is to be used for attempt in local control of unresectable pancreatic cancer.

Adult↗
PubMed1979

Stomal polypoid hypertrophic gastritis: a polypoid gastric lesion at gastroenterostomy site.

Four cases of stomal polyps (the so-called gastritis cystica polyposa--GCP) at the gastroenterostomy site were studied with detailed description of their macroscopic and histologic features. Thirty-eight cases with reresection of the stomach including the site of previous gastroenterostomy were used for a comparative study. In 25 (66%) of the 38 cases localized mucosal hypertrophy of varying degrees was recognized near the site of anastomosis, the morphology corresponding well, though of the smaller scale, to that of the GCP both macroscopically and histologically. Macroscopic and histologic continuity was traced between the minimal protrusion of the stomal gastric mucosa and the stomal polyps. It is suggested that the GCP is an extreme occasion of stomal gastritis characterized by atrophy and pseudopyloric gland metaplasia of the fundic glands often with their submucosal invasion and hyperplasia of the surface and foveolar epithelia, these being probably caused by reflux of duodenal contents. It must be borne in mind that such lesions do exist at the site of gastrojejunostomy to be strictly differentiated from malignancies at the gastric stump.

Adult↗
PubMed1977

[Bacterial flora and nitrite production in the stomach after gastroenterostomy. Experimental aspects of the pathogenesis of carcinoma in the operated stomach (author's transl)].

A gastroenterostomy without enteroanastomosis leads to a change in the bacterial flora of the stomach, where-by in particular the proportion of nitrite-decomposing bacteria, is enhanced. This results in an increase of nitrite concentration in the gastric fluid, which may possibly be accompanied by an augmented production of carcinogenic nitrosoamine. This latter aspect is considered with respect to the origin of carcinoma in the operated stomach. Since the reported changes will be largely prevented by a Roux-Y-gastroenterostomy, this should be taken into consideration for reconstruction of the alimentary tract after gastric surgery.

Animals↗
PubMed1977

Double gastroenterostomy tube in gastric surgery.

This report describes a new double gastroenterostomy tube. It has been used in patients where delayed oral feedings are anticipated, ie, a perforated duodenal ulcer, suture-plicated, with stenosis of the duodenum; a duodenal ulcer with outlet obstruction treated with vagotomy and gastroenterostomy; and patients with chronic lung disease undergoing gastric surgery and requiring postoperative respiratory assistance. Its use has proved to be beneficial, and it is cheap and allows early enteric feeding.

Enteral Nutrition↗
PubMed1992

CT guidance for percutaneous gastrostomy and gastroenterostomy.

The authors describe the value of computed tomographic (CT) guidance for percutaneous gastrostomy (PG) or gastroenterostomy (PGE) in 22 patients with anatomic or pathologic difficulties precluding fluoroscopic guidance. Indications for PG or PGE were decompression for gastrointestinal obstruction (n = 15) or for feeding (n = 7). Thirteen patients previously underwent an unsuccessful attempt at or had been rejected as unsuitable for percutaneous endoscopic gastrostomy. CT guidance was selected because of inability to pass a nasogastric tube due to esophageal obstruction (n = 4), inability to tolerate gastric distention (n = 1), abnormal morphology in or around the stomach (n = 16), or simultaneous performance of a PG in one patient who was undergoing emergency CT-guided abscess drainage. Catheters were placed successfully in all 22 patients. No major complications occurred. CT is valuable for PG or PGE when anatomic or pathologic problems make fluoroscopic or endoscopic puncture unsafe or impossible.

Adult↗
PubMed1990

Fluoroscopically guided percutaneous gastrostomy and gastroenterostomy: analysis of 158 consecutive cases.

We reviewed our experience with 158 consecutive patients who underwent either percutaneous gastrostomy or percutaneous gastroenterostomy during a 2-year period. The catheters used included Foley catheters (36), Cope-type gastric catheters (86), or Carey-Alzate-Coons gastrojejunostomy catheters (36). Gastrojejunostomy tubes were placed in patients with gastroesophageal reflux or aspiration, gastric atony, or partial gastric obstruction. Ninety percent of the tubes were placed for feeding purposes. The technical success rate was 100%. Thirty-day follow-up was obtained in 89%. Thirty-day mortality was 26%, reflecting the substantial number of debilitated patients. No deaths were directly related to tube placement. Major morbidity was 6% and included hemorrhage, peritonitis, tube migration, and sepsis. Minor morbidity was 12%. There was no difference in 30-day mortality or feeding tolerance between the tube types (p less than .05). Patients with Foley catheters had more complications necessitating surgical intervention and an increased incidence of tube changes required within 30 days. These were the only statistically significant differences between the tubes (p less than .05). Our results show that percutaneous gastrostomy is a safe and effective means of gastroenteric feeding or decompression. Because of the fewer complications and ease of insertion, the Cope type of gastrostomy tube has become our preferred catheter for percutaneous feeding or decompression.

Aged↗
PubMed1975

[Surgical treatment of peptic ulcer after gastroenterostomy].

Based on a comparison of the immediate and late results of treatment in patients with peptic ulcers following gastroenterostomy by means of gastric resection (24 patients) and by vagotomy, it is concluded that vagotomy in most cases results in a complete cure of patients, thus this procedure is felt to be more advantageous than gastric resection due to its technical feasibility and small operative risk.

Follow-Up Studies↗
PubMed1977

[Gastroenterostomy, indications--complications--reparation (author's transl)].

After presenting the indications of the gastroenterostomy in accordance with current valid pronciples, the early and late postoperative disturbances and their corrections are described. The main immediate complications is the gastric paralysis of the stomach and later the peptic jejunal ulcer. Conservative therapy as well as possible, surgical treatment, especially the degastroenterostomy with and without resection are mentioned.

Aged↗
PubMed1990

Duodenal obstruction in advanced pancreatic carcinoma: how effective is gastroenterostomy in palliation?

Gastro-enterostomy produces variable and often disappointing results in the management of duodenal obstruction due to advanced pancreatic carcinoma. In a series of 51 patients who had palliative surgery for carcinoma of the pancreas five required a gastro-enterostomy. Three of these subsequently had difficulty with gastric emptying. The problem of gastro-enterostomy failure in palliation of pancreatic carcinoma is discussed.

Aged↗