Endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing self-expanding metal stent for decompression of afferent loop obstruction

Taunk, Pushpak; Cosgrove, Natalie; Loren, David E.; Kowalski, Thomas E.; Siddiqui, Ali A.

doi:10.1055/s-0034-1392564

Cited by 19 publications

(26 citation statements)

References 3 publications

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“…Imageguided percutaneous drainage and endoscopic stent placement have been reported as palliative methods for malignant causes in specialized centres. [4] Conclusion Even though acute ALS is a rare complication, it must be considered as a differential diagnosis for acute abdomen in patients who have previously undergone Roux-en-Y reconstruction considering the necessity of early diagnosis and surgical intervention to reduce the mortality. Ÿ Early surgical intervention is needed for acute ALS to reduce mortality.…”

Section: Discussionmentioning

confidence: 99%

Afferent loop syndrome caused by stenosis of jejunojejunal anastomosis of Roux-en-Y reconstruction

Silva¹,

Karunadasa²,

Madugalle³

et al. 2019

Sri Lanka j Surg

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Section: Discussionmentioning

confidence: 99%

Afferent loop syndrome caused by stenosis of jejunojejunal anastomosis of Roux-en-Y reconstruction

Silva¹,

Karunadasa²,

Madugalle³

et al. 2019

Sri Lanka j Surg

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“…I N TOTAL, 19 studies and case reports were identified and included in the review [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] (Table 1 and Fig. S1).…”

Section: Literature Reviewmentioning

confidence: 99%

What is the ideal indwelling time for metal stents after endoscopic ultrasound‐guided gastrojejunostomy? Case report of delayed iatrogenic perforation with a review of the literature

Taïbi

Fontanier

Derbal

et al. 2020

Digestive Endoscopy

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Several recent studies have described the feasibility, efficacy and safety of the placement of lumen‐apposing metal stents (LAMS) for the treatment of gastrointestinal strictures. However, the optimum stent indwelling time is unclear. We reviewed the literature on endoscopic gastroenterostomy (GE) with a focus on the stent indwelling time and we described the first reported case of iatrogenic perforation six months after Axios stent placement. In the literature review (n = 239), the composite technical success rate and clinical success rate were 93.7% and 87.9%, respectively. The mean follow‐up period was 191 days, and the mean stent indwelling time was 88 days. Among 13 studies (n = 202), the mean rate of complications was 13.4%. The principal complication was mis‐deployment of the stent (4.5%). We report a case report of delayed iatrogenic perforation. A 59‐year‐old male patient with cystic dystrophy of the duodenum has been followed for several years. He presented with anorexia following duodenal obstruction and underwent endoscopic ultrasound‐guided gastrojejunostomy. Six months later, he was referred to our center due to septic shock, and abdominal computed tomography revealed peritonitis secondary to a perforation of the small intestine, opposite the Axios stent. The mean LAMS indwelling time after GE was 88 days. To minimise the rate of adverse events, such as ulceration and mucosal overgrowth, regular abdominal computed tomography and endoscopy can be performed to evaluate the local effect of the stent. When the disease has resolved, the LAMS must be removed as soon as possible.

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“…A previous report has demonstrated the usefulness of LAMS for transenteric drainage of pancreatic pseudocysts and the gallbladder [2]. Recently, EUS-guided transgastric access into the afferent limb with LAMS has been reported [3,4].The use of the Hot AXIOS system has some advantages compared with conventional LAMS, namely, avoidance of the need to exchange devices for stent placement, shortening of procedure time, prevention of leakage in the abdominal cavity, and prevention of separation of the digestive wall and afferent loop tract wall during the procedure.Therefore, EUS-guided drainage with LAMS is a safe, easy-to-perform, and highly effective minimally invasive treatment modality for afferent loop syndrome. …”

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confidence: 98%

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confidence: 99%

Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system

et al. 2017

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Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system Afferent loop syndrome is a complication that infrequently occurs after pancreaticoduodenectomy [1]. Complete obstruction occurs which leads to cholangitis, pancreatitis, perforation, and necrosis. In particular, patients with cancer recurrence cannot continue chemotherapy treatment, become debilitated, and may eventually die. Therefore, early and appropriate decompression treatment is needed. This report describes endoscopic ultrasound (EUS)-guided gastrojejunostomy for treatment of afferent loop syndrome, using a lumen-apposing metal stent (LAMS) incorporated into an electrocautery-enhanced delivery system. A 44-year-old man was admitted to our hospital with vomiting and abdominal pain; he had undergone pancreatoduodenostomy for pancreatic head cancer 11 months earlier. Computed tomography (CT) revealed dilation of the afferent loop associated with a recurrence of cancer (▶ Fig. 1). First, multiple plastic stents were inserted by balloon-assisted enteroscopy (▶ Fig. 2) and his clinical condition improved. However, 1 month later he was admitted again with abdominal pain because of stent occlusion. CT revealed dilation of the afferent loop and intrahepatic bile duct (▶ Fig. 3). We performed EUS-guided gastrojejunostomy with a LAMS incorporated into an electrocautery-enhanced delivery system (Hot AXIOS; Boston Scientific, Natick, Massachusetts, USA) (▶ Fig. 4, ▶ Video 1). CT on the following day showed improvement in the dilation of the afferent loop (▶ Fig. 5). The patient showed resolution of clinical symptoms and received outpatient chemotherapy. A previous report has demonstrated the usefulness of LAMS for transenteric drainage of pancreatic pseudocysts and the gallbladder [2]. Recently, EUS-guided transgastric access into the afferent limb with LAMS has been reported [3,4].The use of the Hot AXIOS system has some advantages compared with conventional LAMS, namely, avoidance of the need to exchange devices for stent placement, shortening of procedure time, prevention of leakage in the abdominal cavity, and prevention of separation of the digestive wall and afferent loop tract wall during the procedure.Therefore, EUS-guided drainage with LAMS is a safe, easy-to-perform, and highly effective minimally invasive treatment modality for afferent loop syndrome. Endoscopy_UCTN_Code_TTT_1AR_2ADVideo 1 Endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system, for treatment of afferent loop syndrome.▶ Fig. 1 Computed tomography (CT) revealed dilation of the afferent loop associated with a recurrence of cancer, in a 44-year-old man who had undergone pancreatoduodenostomy for pancreatic head cancer 11 months previously. E-Videos E270

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Endoscopic ultrasound-guided gastroenterostomy using a lumen-apposing self-expanding metal stent for decompression of afferent loop obstruction

Cited by 19 publications

References 3 publications

Afferent loop syndrome caused by stenosis of jejunojejunal anastomosis of Roux-en-Y reconstruction

Afferent loop syndrome caused by stenosis of jejunojejunal anastomosis of Roux-en-Y reconstruction

What is the ideal indwelling time for metal stents after endoscopic ultrasound‐guided gastrojejunostomy? Case report of delayed iatrogenic perforation with a review of the literature

Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system

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