Jaboulay vs gastrojejunostomy: long-term recurrence
What is the evidence on long-term recurrence of duodenal strictures after Jaboulay strictureplasty versus gastrojejunostomy
What is known
- Yamamoto (Birmingham) reported ~46% restricture at the prior strictureplasty site and ~23% needing reoperation for early complications, concluding strictureplasty was associated with higher repeat stricturing than gastrojejunostomy. 1,2
- A meta-analysis attributes the Birmingham vs Cleveland Clinic discordance partly to differing follow-up (median 143 months vs mean 42 months), which likely inflated the recurrence signal against strictureplasty. 3
- Worsey et al found similar reoperation rates between groups (strictureplasty 15%, bypass 10%), but marginal ulceration, dumping, and delayed gastric emptying were higher after bypass. 4
- Two studies of similar size reached opposite conclusions on whether strictureplasty or bypass is preferable for duodenal CD, so comparative superiority cannot be established. 5
What is unknown / caveats
- Birmingham/Yamamoto: strictureplasty inferior with high restricture vs bypass; Cleveland Clinic: strictureplasty safe/effective, low recurrence
- Longer follow-up in the Birmingham cohort (143 vs 42 mo) may explain the higher measured recurrence
- No direct head-to-head randomized comparison; all data are small retrospective single-institution cohorts
- 'Jaboulay strictureplasty' specifically is rarely reported in isolation. Most series pool duodenal strictureplasty techniques and bypass is often Roux-en-Y gastrojejunostomy
- Whether the higher restricture signal reflects the technique or simply longer follow-up in the Birmingham cohort cannot be resolved from these data.
References
- 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.
- Yamamoto T, Watanabe T. Surgery for luminal Crohn's disease. World J Gastroenterol. 2014;20(1):78-90. PMID: 24415860.
- [No authors listed]. Safety and efficacy of strictureplasty for Crohn's disease: a systematic review and meta-analysis. Dis Colon Rectum. 2007;50(11):1968-86. PMID: 17762967.
- [No authors listed]. Crohn's Disease of the Esophagus, Duodenum, and Stomach. Clin Colon Rectal Surg. 2019;32(4):231-242. PMID: 31275069.
- Orrell M, van 't Hullenaar C, Gosling J. Upper gastrointestinal tract involvement in Crohn's disease: A case report. Int J Surg Case Rep. 2021. PMID: 33887830.
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⚠ Required context not in this corpus (moderate). A rigid FIBROTIC (fibrostenotic, non-inflammatory) stricture is the classic INDICATION for bowel-sparing strictureplasty, not a contraindication. The contraindications are sepsis, phlegmon, fistula, and suspected malignancy.
Why this matters: Calling fibrotic stricture a contraindication inverts the indication and steers a bowel-sparing candidate to resection.
Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper. Not generated by the RAG.
⚠ Required context not in this corpus (moderate). Endoscopic balloon dilation is an established option for short (<5 cm) fibrostenotic and anastomotic Crohn's strictures, with high technical success and low complication rates (Bettenworth 2017 pooled analysis, PMID 28002130). It can defer or avoid repeat resection.
Why this matters: Presenting the choice as medical therapy versus repeat resection omits the bowel-sparing option that a suitable short stricture should be offered first.
Added by the landmark interlock. This corpus is surgical in scope and cannot admit the source paper (PMID 28002130). Not generated by the RAG.
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.
Reviewer notes