title: Endoscopic vs. laparoscopic gastrojejunostomy for duodenal obstruction: a randomized study in a porcine model.
abstract: OBJECTIVE
  Open or laparoscopic gastrojejunostomy is an established treatment for malignant duodenal obstruction but may be associated with significant morbidity and mortality. The purpose of this study was to develop a model for an entirely endoscopic gastrojejunostomy to treat duodenal obstruction, and to compare this with the laparoscopic technique.
  
  
  METHODS
  During the first part of the study the endoscopic technique was developed and tested in porcine nonsurvival and survival experiments (n=12). During the second part of the study (n=10), endoscopic gastrojejunostomy for duodenal occlusion was compared with laparoscopic gastrojejunostomy in a survival randomized controlled trial (RCT). For both groups duodenal occlusion was achieved by the laparoscopic approach.
  
  
  RESULTS
  In the RCT, the median times for laparoscopic vs. endoscopic gastrojejunostomy were 70 minutes (interquartile range [IQR] 65-75) vs. 210 minutes (IQR 197-220; P=0.01). There was a trend toward increased anastomotic diameter at necropsy in the laparoscopic group (2 cm, IQR 2-3) compared to the endoscopic group (1.8 cm, IQR 1.6-1.8; P=0.06). One animal in the endoscopic group died secondarily to bowel ischemia from volvulus of the jejunal loop. One animal in the laparoscopic group was prematurely sacrificed due to extensive pulmonary congestion and edema. All anastomoses were intact and patent.
  
  
  CONCLUSIONS
  Purely endoscopic gastrojejunostomy using the developed technique and devices is feasible and can result in adequate relief of duodenal obstruction. Endoscopic anastomoses tend to be smaller than laparoscopic anastomoses, with the procedures being more time-consuming and associated with higher complication rates.
authors: Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Richard.I.Rothstein@Hitchcock.ORG
authors: D
authors: D
authors: von Renteln
authors: M C
authors: MC
authors: Vassiliou
authors: D
authors: D
authors: McKenna
authors: A A
authors: AA
authors: Suriawinata
authors: C P
authors: CP
authors: Swain
authors: R I
authors: RI
authors: Rothstein
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004380:Duodenal Obstruction / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005260:Female; D015390:Gastric Bypass / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D011897:Random Allocation; D034421:Sus scrofa; D016896:Treatment Outcome