Endoscopic Ultrasound-Guided Enteroenterostomy for Afferent Limb Syndrome

Bacha, H El; Leblanc, Sarah; Bordaçahar, Benoît; Brieau, Bertrand; Barret, Maximillien; Savier, Eric; Soubrane, Olivier; Dousset, B.; Prat, Frédéric

doi:10.14309/crj.0000000000000442

Cited by 6 publications

(4 citation statements)

References 12 publications

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“…The dilated and bile-filled obstructed loop can be identified by the echoendoscope placed in an adjacent lumen, either the stomach, duodenum, or proximal jejunum, and drained through placement of a LAMS. Multiple case reports and some small retrospective case series have described this procedure [175][176][177][178][179]. The largest published series to date (retrospective, multicenter, n = 18), which used mainly LAMSs of 15 mm in diameter, showed 100 % technical success and clinical improvement rates (89 % complete resolution), with re-intervention required in 17 % of patients [175].…”

Section: Eus-ge In Malignant Gastric Outlet Obstructionmentioning

confidence: 99%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2 ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers.Weak recommendation, moderate quality evidence. 3 ESGE recommends that EUS-guided pancreatic duct (PD) drainage should only be considered in symptomatic patients with an obstructed PD when retrograde endoscopic intervention fails or is not possible.Strong recommendation, low quality evidence. 4 ESGE recommends rendezvous EUS techniques over transmural PD drainage in patients with favorable anatomy owing to its lower rate of adverse events.Strong recommendation, low quality evidence. 5 ESGE recommends that, in patients at high surgical risk, EUS-guided gallbladder drainage (GBD) should be favored over percutaneous gallbladder drainage where both techniques are available, owing to the lower rates of adverse events and need for re-interventions in EUS-GBD.Strong recommendation, high quality of evidence. 6 ESGE recommends EUS-guided gastroenterostomy (EUS-GE), in an expert setting, for malignant gastric outlet obstruction, as an alternative to enteral stenting or surgery.Strong recommendation, low quality evidence. 7 ESGE recommends that EUS-GE may be considered in the management of afferent loop syndrome, especially in the setting of malignancy or in poor surgical candidates. Strong recommendation, low quality evidence. 8 ESGE suggests that endoscopic ultrasound-directed transgastric ERCP (EDGE) can be offered, in expert centers, to patients with a Roux-en-Y gastric bypass following multidisciplinary decision-making, with the aim of overcoming the invasiveness of laparoscopy-assisted ERCP and the limitations of enteroscopy-assisted ERCP.Weak recommendation, low quality evidence.

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Section: Eus-ge In Malignant Gastric Outlet Obstructionmentioning

confidence: 99%

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…In ALS, EUS‐A is gaining ground, although previous studies are limited to case series including heterogeneous groups of patients with different surgical anatomy and baseline conditions. A recent case series 11 reported a technical success of 100%, with no related adverse events in five patients with ALS and a previous surgery of Roux‐en‐Y or pancreatoduodenectomy treated by EUS‐A using a 15 mm stent. Percutaneously assisted EUS‐guided gastrojejunostomy 12 and EUS‐guided jejunojejunostomy 5,13 have also been described.…”

Section: Discussionmentioning

confidence: 97%

Endoscopic ultrasound‐guided drainage using lumen‐apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video)

Pérez-Cuadrado-Robles

Bronswijk

Prat

et al. 2022

Digestive Endoscopy

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Objectives: Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS.Methods: This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated.Results: Forty-five patients (mean age: 65.5 AE 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique

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“…Recently, EUS-guided gastroenterostomy (EUS-GE) has been introduced as an alternative in the management of malignant ALO [ 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Technical and clinical success rates have been reported as 92–100% and 85–100%, respectively.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction

Yonekura

Sasaki

Mie

et al. 2022

JCM

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Background: Malignant afferent loop obstruction (ALO) is rare condition and is difficult to manage. Endoscopic transluminal treatment has become easier with the advent of balloon-assisted enteroscopes with a large working channels and self-expandable metal stent (SEMS) with a 9 Fr delivery system. Methods: From July 2016 to March 2022, 22 patients with symptomatic malignant ALO who underwent endoscopic transluminal treatment (Initial cohort), of which 18 patients received endoscopic transluminal SEMS placement (SEMS cohort), were retrospectively evaluated. We evaluated outcomes of endoscopic transluminal treatment and long-term outcomes of SEMS placement for malignant ALO. Results: In the Initial cohort, technical and clinical success rates were both 95.5%. The median procedural time was 28.0 min. One case of guidewire-induced micro-perforation occurred as an early complication (4.5%). In the SEMS cohort, and no early complication was observed. Recurrent obstruction occurred in two cases (11.1%) during the follow-up period (median: 102 days). One was managed by additional SEMS placement and the other was treated conservatively. Conclusions: High technical and clinical success was achieved by endoscopic transluminal treatment with short procedural time for malignant ALO. Endoscopic SEMS placement also appears to be safe and effective, and additional SEMS placement can be considered in cases of re-obstruction.

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Endoscopic Ultrasound-Guided Enteroenterostomy for Afferent Limb Syndrome

Cited by 6 publications

References 12 publications

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic ultrasound‐guided drainage using lumen‐apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video)

Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction

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