Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy

Abstract

Afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy (PD) can be managed by either surgical or nonsurgical treatment. The general condition of patients with recurrent pancreaticobiliary cancer is often not good enough for them to undergo surgery, so less invasive nonsurgical treatment is desirable. We report a case of a 66-year-old male who had undergone PD for pancreatic head adenocarcinoma 10 months previously and who presented at our hospital with fever and jaundice due to afferent loop obstruction caused by pancreatic cancer recurrence. An endoscopic self-expandable metal stent (SEMS) was placed for afferent loop obstruction without any complications. He quickly recovered after SEMS placement. He retained a good quality of life by receiving chemotherapy until his death due to cancer progression. Our case indicates that this method could be an easy, effective, safe, and less invasive treatment, which may confer a better quality of life for patients with afferent loop obstruction due to cancer recurrence after PD.

Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review

“…Previously, we reported a case of malignant ALO arising after PD that was successfully treated by endoscopic SEMS placement. 2 However, the clinical outcomes of endoscopic SEMS placement for malignant ALO following PD remain to be evaluated. Herein, we report 7 cases of endoscopic SEMS placement for malignant ALO that arose after PD.…”

Management of Obstructed Afferent-Loop due to Recurrence of Pancreatic Adenocarcinoma using an Enteral Self-Expanding Metal Stent

“…One of the main endoscopic techniques used in these cases is the placement of self-expanding metallic stents for bile drainage, with high success rates when conducted by experienced hands, and preventing external percutaneous access through interventional radiology, which could give rise to midand long-term complications. As described by A Sakai et al [12] in their report of a 66-year-old male patient with malignant afferent loop syndrome due to recurrence of a pancreatic cancer tumor, where a self-expanding metallic stent with a diameter of 22 mm and a length of 8 cm was used on the stenosis site, after decompressing the dilated afferent loop with a nasojejunal tube of 7.5 Fr for six days, with optimum short-and mid-term results. In our patient, we also used a metallic endoprosthesis similar to the case reported, but through a 0.035-inch guide placed with initial help of a balloon-assisted enteroscope, due to the particular narrowness of the lesion, followed by therapeutic endoscope to deliver the stent.…”

Endoscopic approaches to afferent and Roux-en-Y limb obstruction

“…Although access has been primarily used to perform endoscopic retrograde cholangiopancreatography in patients with postoperative anatomy, SEMS can be placed through the enteroscope overtube under fluoroscopic control after removal of the endoscope. [21][22][23][24] This overcomes the small enteroscope working channel (2.8 mm) which precludes passage of currently marketed SEMS delivery catheters.…”

“…Approached percutaneously, [9][10][11] surgically, [12][13][14][15][16][17][18][19] and endoscopically, [20][21][22][23] contingent upon clinical presentation, patient fitness, and institutional expertise, this review will focus on evolving endoscopic approaches to the obstructed afferent and Roux limbs.…”