Download PDF
CC BY 4.0 · Endoscopy
DOI: 10.1055/a-2544-8507
Innovations and brief communications

Reversible endoscopic gastroduodenal bypass for the treatment of persistent duodenal leaks after failed surgical repair: a pilot feasibility study

Kambiz Kadkhodayan 
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Saurabh Chandan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Artur Viana
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
2   Gastroenterology, New York University, New York, United States
,
Maham Hayat
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Natalie Cosgrove
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Mustafa A Arain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Deepanshu Jain
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Abdullah Abassi
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Sagar Pathak
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Dennis Yang
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Muhammad Khalid Hasan
3   Center for Interventional Endoscopy, Florida Hospital Orlando, Orlando, United States
,
Armando Rosales
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Jay Redan
1   Center for Interventional Endoscopy, AdventHealth Orlando, Orlando, United States (Ringgold ID: RIN440172)
,
Shayan Irani
4   Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, United States
› Author Affiliations
› Further Information
Also available at
  Permissions and Reprints

Referred to by:

Endoscopy – surgery: the sliding doorsEndoscopy eFirst
DOI: 10.1055/a-2595-0112

Abstract

Background

Post-surgical leaks following surgical repair of acute duodenal perforations carry high mortality. Reversible endoscopic gastroduodenal bypass (REGB) is a novel procedure that helps divert the acid-rich gastric stream away from the affected duodenum to promote tissue healing at the ulcer site.

Methods

REGB is a single-session, two-step procedure involving the creation of an endoscopic ultrasound-guided gastrojejunostomy using a lumen-apposing metal stent, followed by endosuturing and closure of the pylorus to achieve complete duodenal bypass. The outcomes of REGB and its reversal were prospectively evaluated in six patients with persistent post-surgical duodenal leaks.

Results

REGB was technically successful in all six patients (100%) with no procedure-related adverse events. All patients resumed oral intake within 3 days, experienced significant reductions in surgical drain output, and were discharged. One patient with metastatic breast cancer did not undergo REGB reversal. Among five patients who underwent REGB reversal after a mean of 52.6 days, technical success was achieved in all (100%), with complete healing of duodenal ulcers, absence of leaks on fluoroscopy, and resumption of a solid food diet.

Conclusion

REGB is a technically feasible, reversible, and minimally invasive alternative for managing post-surgical duodenal leaks. Further studies are needed to validate its safety and efficacy.

Supplementary Material



Publication History

Received: 18 September 2024

Accepted after revision: 21 February 2025

Accepted Manuscript online:
24 February 2025

Article published online:
14 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References

  • 1 Bojanapu S, Malani RA, Ray S. et al. Duodenal perforation: outcomes after surgical management at a tertiary care centre – a retrospective cross-sectional study. Surg Res Pract 2020; 2020: 8392716
    CrossrefPubMedSearch in Google Scholar
  • 2 Hermansson M, Staël von Holstein C, Zilling T. Surgical approach and prognostic factors after peptic ulcer perforation. Eur J Surg 1999; 165: 566-572
    CrossrefPubMedSearch in Google Scholar
  • 3 Testini M, Portincasa P, Piccinni G. et al. Significant factors associated with fatal outcome in emergency open surgery for perforated peptic ulcer. World J Gastroenterol 2003; 9: 2338-2340
    PubMedSearch in Google Scholar
  • 4 Wig JD, Kudari A, Yadav TD. et al. Pancreas preserving total duodenectomy for complex duodenal injury. JOP 2009; 10: 425-428
    PubMedSearch in Google Scholar
  • 5 Clinch D, Damaskos D, Di Marzo F. et al. Duodenal ulcer perforation: a systematic literature review and narrative description of surgical techniques used to treat large duodenal defects. J Trauma Acute Care Surg 2021; 91: 748-758
    CrossrefPubMedSearch in Google Scholar
  • 6 Vaughan GD, Frazier OH, Graham DY. et al. The use of pyloric exclusion in the management of severe duodenal injuries. Am J Surg 1977; 134: 785-790
    CrossrefPubMedSearch in Google Scholar
  • 7 Khalifa MS, Hamed MA, Elhefny AM. Management of perforated large/giant peptic ulcers: a comparative prospective study between omental plug, duodenal exclusion, and jejunal serosal patch. The Egyptian Journal of Surgery 2021; 40: 663-672
    PubMedSearch in Google Scholar
  • 8 Machado NO. Management of duodenal perforation post-endoscopic retrograde cholangiopancreatography. When and whom to operate and what factors determine the outcome? A review article. JOP 2012; 13: 18-25
    PubMedSearch in Google Scholar
  • 9 Feliciano DV, Martin TD, Cruse PA. et al. Management of combined pancreatoduodenal injuries. Ann Surg 1987; 205: 673-680
    CrossrefPubMedSearch in Google Scholar
  • 10 Berne CJ, Donovan AJ, White EJ. et al. Duodenal “diverticulization” for duodenal and pancreatic injury. Am J Surg 1974; 127: 503-507
    CrossrefPubMedSearch in Google Scholar
  • 11 Kadkhodayan K, Hussain A, Khan H. et al. Endoscopic pyloric exclusion–EUS-guided gastrojejunostomy combined with endoscopic suturing and closure of the pylorus: a novel approach to failed surgical repair of a perforated duodenal ulcer. VideoGIE 2023; 8: 121-123
    PubMedSearch in Google Scholar
  • 12 Wang YL, Chan XW, Chan KS. et al. Omental patch repair of large perforated peptic ulcers ≥25 mm is associated with higher leak rate. J Clin Transl Res 2021; 7: 759-766
    PubMedSearch in Google Scholar
  • 13 Maghsoudi H, Ghaffari A. Generalized peritonitis requiring re-operation after leakage of omental patch repair of perforated peptic ulcer. Saudi J Gastroenterol 2011; 17: 124-128
    CrossrefPubMedSearch in Google Scholar
  • 14 Liu J, Zhou S, Wang S. et al. Analysis of risk factors for duodenal leak after repair of a duodenal perforation. BMC Surg 2023; 23: 116
    CrossrefPubMedSearch in Google Scholar
  • 15 Wilhelmsen M, Møller MH, Rosenstock S. Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort. Br J Surg 2015; 102: 382-427
    CrossrefPubMedSearch in Google Scholar
  • 16 Tarasconi A, Chiara O, Cimbanassi S. et al. Open abdomen complications: prevention and management. In: Coccolini F, Ivatury R, Sugrue M, Ansaloni L. , ed. Open abdomen: a comprehensive practical manual. Cham: Springer International Publishing; 2018: 215-228
    Search in Google Scholar