Hepaticogastrostomy: ulcerogenic preparation or therapeutic alternative

Recent laboratory and clinical studies have implicated bile salts in the patogenesis of gastric ulceration. Common hepatic duct to stomach anastomosis results in total diversion of bile to the stomach and has been utilized at the Lahey Clinic occasionally for bypass of the obstructed common bile duct in difficult technical situations where conventional procedures were deemed prohibitively difficult. Of seven patients undergoing hepaticogastrostomy, two had upper gastrointestinal bleeding in followup. One of these patients had documented esophageal varices and stopped bleeding after splenorenal shunt. The other had massive sepsis which predisposed him to gastric ulceration. From this small series it is clear that the entire biliary output of the liver can be shunted into the stomach without greatly increased risk of clinically significant gastric ulceration. Hepaticogastrostomy provided relief from jaundice in all but one of the seven patients in the series and remains an occasionally useful procedure. These data indicate that diversion of the entire flow of bile from the liver into stomach does not cause gastric ulcers.