Endoscopic management of afferent loop syndrome of malignant etiology

Burdick, J. Steven; Garza, Aldo A.; Magee, David J.; Dykes, Cathy; Jeyarajah, Rohan

doi:10.1067/mge.2002.122584

Cited by 34 publications

(30 citation statements)

References 10 publications

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“…22,23 Therefore, early diagnosis is important, and proper surgical treatment is strongly recommended in order to prevent worsening of the patient's condition. 24,25 Traditionally, surgery has been the treatment of choice for ALS. Surgical management options for ALS after Billroth-II gastrojejunostomy depend on the etiology and acuteness of the ALS as well as patient clinical status.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure for bile drainage secondary to biliary or intrahepatic obstruction due to calculus, malignancy, or benign tumors. Since PTBD was first described for the treatment of obstructive jaundice by Glen et al, 13 it has been an effective and common intervention for bile drainage.…”

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confidence: 99%

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Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Kim

Lee

Kim

et al. 2016

International Surgery

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The aim of this study was to elucidate the role of percutaneous transhepatic biliary drainage (PTBD) in patients with duodenal stump leakage (DSL) and afference loop syndrome (ALS) postgastrectomy for malignancy or benign ulcer perforation. Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS postgastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12 to 71) in DSL group and 16.4 days (range, 6 to 48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1 to 7) in the ALS group and within 3.4 days (range, 0 to 15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS postgastrectomy.Key words: Gastrectomy -PTBD -Duodenal stump leakage -Afferent loop syndrome P ostoperative complications after gastrectomy are difficult for both patients and surgeons. In the past, most of the major complications after gastrectomy required re-operation. The rate of reoperation for these complications ranges from 2.8% to 10%. 1-3 After gastrectomy, duodenal stump leak-

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Kim

Lee

Kim

et al. 2016

International Surgery

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“…Some cases of successful SEMS placement via the transhepatic route have been reported for the treatment of afferent loop obstruction caused by cancer recurrence [11,12]. However, an endoscopic approach would be less invasive and technically easier than a transhepatic approach if an endoscope can reach the site of stenosis in the afferent loop [14]. Recently, double-balloon endoscopy has also been used to reach the stenosis and place SEMS in cases where it cannot be achieved by a standard scope due to the method of reconstruction after PD [15].…”

Section: Discussionmentioning

confidence: 99%

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

Sakai

Shiomi

Okabe

et al. 2015

Clin J Gastroenterol

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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.

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“…This complication is a potentially serious and life-threatening event that induces intraabdominal abscesses and postoperative hemorrhage and therefore prolongs hospital stays and increases treatment costs (4). Afferent limb syndrome is a considerable complication following reconstruction during PD and bile duct resection, and may be fatal if cholangitis and jaundice develop (17). This condition results from afferent limb obstruction and is caused by postoperative adhesions, afferent limb kinking, and delayed complications such as radiation enteritis and tumor recurrence (5,13).…”

Section: Discussionmentioning

confidence: 99%

“…Although PTBD provides excellent symptom relief, it may introduce the risk of retrograde biliary infection and is unsuitable for patients with massive ascites (13)(14)(15). Recently, the efficacy of metallic stent placement to treat afferent loop syndrome via the PTBD route has been described (13,16), and the usefulness of endoscopic intervention for afferent limb syndrome has also been reported (5,17). However, these procedures may be technically difficult in patients with adhesions or massive ascites.…”

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confidence: 99%

Percutaneous Drainage for Afferent Limb Syndrome and Pancreatic Fistula via the Blind End of the Jejunal Limb after Pancreatoduodenectomy or Bile Duct Resection

Sato

Inaba

Murata

et al. 2015

Journal of Vascular and Interventional Radiology

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Endoscopic management of afferent loop syndrome of malignant etiology

Cited by 34 publications

References 10 publications

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

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

Percutaneous Drainage for Afferent Limb Syndrome and Pancreatic Fistula via the Blind End of the Jejunal Limb after Pancreatoduodenectomy or Bile Duct Resection

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