Periampullary duodenal stricture: Jaboulay or bypass

for a short (2 cm) stricture immediately proximal to the ampulla, a Jaboulay strictureplasty is the ampulla-preserving, bowel-preserving option that bypasses the strictured segment without a formal gastrointestinal bypass, whereas gastrojejunostomy carries the added risks of marginal ulceration, dumping, and delayed gastric emptying ^1,2. the retrieved evidence describes both as feasible but does not provide a head-to-head comparison establishing superiority of either for this exact scenario ¹. ^1–5

What is known:

• A short Jaboulay is specifically advocated for second-portion duodenal strictures to avoid encroaching on the ampulla of Vater, and can bypass the stricture while preserving the ampulla. ^1,2
• Institutional preference is strictureplasty over bypass whenever possible, citing higher risk of marginal ulceration, dumping syndrome, and delayed gastric emptying after bypass; no consensus exists on which is superior. ¹
• Jaboulay gastroduodenostomy is a described option when strictureplasty is unsafe or the segment too tight/inflamed for safe closure, particularly for very proximal/pyloric strictures. ^3,4
• Gastrojejunostomy (Roux-en-Y or antecolic) is a recognized bypass for stricturing duodenal CD, but the 2025 review prefers duodenojejunal over gastrojejunal bypass and avoids a Roux limb to reduce recurrence-prone suture lines. ^1,5

What is unknown / caveats:

• No consensus on whether bypass or strictureplasty is superior for duodenal CD ¹
• No head-to-head Jaboulay vs gastrojejunostomy comparison in the retrieved evidence
• Evidence base is small case series, case reports, and narrative reviews
• Safe mobilization/closure feasibility near the ampulla is the practical determinant and is patient-specific
• Whether the stricture is too tight, inflamed, or scarred for safe strictureplasty near the ampulla determines feasibility and is an intraoperative judgment.

References

1. Khan I, Holubar SD. Operative Management of Small and Large Bowel Crohn's Disease. Surg Clin North Am. 2025;105(2):247-276. PMID: 40015815.

2. [No authors listed]. Bowel preserving surgery for stricturing jejunoileal Crohn's disease, part 4: Jaboulay duodenal strictureplasty: A step-by-step video vignette-A video vignette. Colorectal Dis. 2025;27(12):e70325. PMID: 41366230.

3. Takesue Y, Yokoyama T, Akagi S, Ohge H, Murakami Y, Imamura Y, Uemura K, Kanehiro T, Matsuura Y. Strictureplasty for short duodenal stenosis in Crohn's disease. J Gastroenterol. 2000;35(12):929-32. PMID: 11573730.

4. [No authors listed]. Strictureplasty is an effective option in the operative management of duodenal Crohn's disease. Dis Colon Rectum. 1999;42(5):596-600. PMID: 10344680.

5. Lightner AL. Duodenal Crohn's Disease. Inflamm Bowel Dis. 2018;24(3):546-551. PMID: 29462397.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.