A gastroenterostomy, usually gastrojejunostomy, may be performed as a drainage procedure with vagotomy for peptic ulcer disease and in patients with unresectable antral carcinomas and other conditions that may lead to antral narrowing, such as Crohn's disease. In the past, simple gastroenterostomy was a commonly performed procedure for PUD, although it was abandoned owing to the high ulcer recurrence rate. An anastomosis is generally made between the jejunum and the greater curvature of the stomach, as far as possible from the pylorus, in a side-to-side fashion, although other configurations are sometimes used (Figs. 3.35 and 3.36). The jejunum may be brought either to the anterior wall of the stomach superior to the omentum or to the

Figure 3.35. Gastroenterostomy. (A) Plain film. (B) Upper GI series demonstrating the gastrojejunal anastomoses along the greater curvature of the body of the stomach. Note contrast flows via the anatomic route and the gastrojejunostomy.
Figure 3.36. Gastrojejunostomy. Right anterior oblique view from an upper GI series showing the gastroenterostomy at the distal body of the stomach.

posterior wall through an opening made in the transverse mesocolon. When one is performing a contrast study, it is important to document the direction of the flow of barium out of the stomach, with the preferable route being from the stomach to the efferent limb.

Complications of Gastroenterostomy

Antral Narrowing

Narrowing of the antrum may develop many years after gastro-enterostomy, with or without vagotomy (Fig. 3.37). The etiology is unclear. Narrowing may be due to disuse secondary to exclusion of the antrum, as is known to occur in other portions of the bowel following diversion procedures; or it may be related to antral gastritis with fibro-sis or to postoperative adhesions. The entire antrum or only a portion of the antrum may be affected. The narrowing is typically smooth and concentric. The appearance may be confused with infiltrating carcinoma, which is increased in incidence following gastroenterostomy over the general population [19]. Biopsy may be necessary to establish a definitive diagnosis.

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