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Lam S, Khan S, Hutchins R, Fotheringham T. Extra-anatomic percutaneous stenting of a malignant afferent loop obstruction following pancreaticoduodenectomy. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii210014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Stefan Lam
- Department of Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Sarah Khan
- Department of Imaging, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Robert Hutchins
- Department of Imaging, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Tim Fotheringham
- Department of Imaging, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
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2
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Khan Amin Z, Kanwal R, Nawaz A, Ziad A, Shozab M. Percutaneous Transhepatic Bowel Stent Deployment: An Alternative Approach for Malignant Afferent Loop Obstruction Following Whipple's Procedure. Cureus 2021; 13:e15964. [PMID: 34336457 PMCID: PMC8312993 DOI: 10.7759/cureus.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/25/2022] Open
Abstract
Afferent loop syndrome is an uncommon postoperative complication. Currently, we lack a therapeutic option for treatment of malignant afferent loop obstruction following procedures like Whipple's. Here we present a case of afferent loop obstruction in a known case of pancreatic carcinoma, status after Whipple’s procedure, in which we used a percutaneous transhepatic approach to relieve the afferent loop obstruction using a self-expanding bare metal stent.
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Affiliation(s)
- Zahid Khan Amin
- Interventional Radiology, Shifa International Hospital, Islamabad, PAK
| | - Raana Kanwal
- Diagnostic Radiology, Shifa International Hospital, Islamabad, PAK
| | - Atif Nawaz
- Interventional Radiology, Shifa International Hospital, Islamabad, PAK
| | - Alishbah Ziad
- Diagnostic Radiology, Shifa International Hospital, Islamabad, PAK
| | - Muhammad Shozab
- Interventional Radiology, Shifa International Hospital, Islamabad, PAK
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3
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Sakai A, Shiomi H, Masuda A, Kobayashi T, Yamada Y, Kodama Y. Clinical management for malignant afferent loop obstruction. World J Gastrointest Oncol 2021. [DOI: 10.4251/wjgo.v13.i7.509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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4
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Sakai A, Shiomi H, Masuda A, Kobayashi T, Yamada Y, Kodama Y. Clinical management for malignant afferent loop obstruction. World J Gastrointest Oncol 2021; 13:684-692. [PMID: 34322197 PMCID: PMC8299933 DOI: 10.4251/wjgo.v13.i7.684] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/05/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Afferent loop obstruction (ALO) is defined as duodenal or jejunal mechanical obstruction at the proximal anastomosis site of a gastrojejunostomy. With advances in chemotherapy, the incidence of malignant ALO is increasing. Malignant ALO can be complicated by ischemia, gangrenous bowel, pancreatitis, and ascending cholangitis. Moreover, the general condition of patients with recurrent cancer is often poor. Therefore, accurate and rapid diagnosis and minimally invasive treatments are required. However, no review articles on the diagnosis and treatment of malignant ALO have been published. Through literature searching, we reviewed related articles published between 1959 and 2020 in the PubMed database. Herein, we present recent advances in the diagnosis and treatment of malignant ALO and describe future perspectives. Endoscopic transluminal self-expandable metal stent (SEMS) placement is considered the standard treatment for malignant ALO, as this procedure is well established and less invasive. However, with the development of interventional endoscopic ultrasound (EUS) in recent years, the usefulness of EUS-guided gastrojejunostomy has been reported. Moreover, through indirect comparison, this approach has been reported to be superior to transluminal SEMS placement. It is expected that a safer and less invasive treatment method will be established through the continued advancement and innovation of interventional endoscopy techniques.
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Affiliation(s)
- Arata Sakai
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Hideyuki Shiomi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Atsuhiro Masuda
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Takashi Kobayashi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Yasutaka Yamada
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
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5
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AlGharras A, Dey C, Molla N, Martinez N, Valenti D, Cabrera T, Bessissow A, Torres C, Muchantef K, Boucher LM. Transhepatic Approach for Retrograde D2 Duodenal Stent Placement: New Technique and Case Series. J Vasc Interv Radiol 2021; 32:1221-1226. [PMID: 34015487 DOI: 10.1016/j.jvir.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/16/2021] [Accepted: 05/07/2021] [Indexed: 10/21/2022] Open
Abstract
Transhepatic duodenal stent placement may be a solution when endoscopy fails or when duodenal and biliary stents are needed simultaneously. This approach is usually not considered as an option when the duodenal stent must be deployed across the ampulla of Vater. The authors present a series of 10 patients who underwent a novel transhepatic technique to place a duodenal stent across the ampulla of Vater by establishing a wire scaffold from the liver toward the jejunum and then curving back on itself retrogradely through the duodenal tumor and out the mouth. Technical success was 90% with no associated mortality.
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Affiliation(s)
- Abdulaziz AlGharras
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada; Department of Radiology, College of Medicine and Medical Sciences, Qassim University, Al Qassim, Kingdom of Saudi Arabia
| | - Chris Dey
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada; Department of Radiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nouran Molla
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Nicolas Martinez
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada; Department of Radiology, University of Chile Clinical Hospital, Santiago, Chile
| | - David Valenti
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Tatiana Cabrera
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Ali Bessissow
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Carlos Torres
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Karl Muchantef
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada
| | - Louis-Martin Boucher
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, Québec, Canada.
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6
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Hu HT, Ma FH, Wu ZM, Qi XH, Zhong YX, Xie YB, Tian YT. Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports. World J Clin Cases 2020; 8:5353-5360. [PMID: 33269270 PMCID: PMC7674735 DOI: 10.12998/wjcc.v8.i21.5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Afferent loop syndrome (ALS) is a rare mechanical complication that occurs after reconstruction of the stomach or esophagus to the jejunum, such as Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagoje-junostomy. Traditionally, an operation is the first choice for benign causes. However, for patients in poor physical condition who experience ALS soon after R0 resection, the type of treatment remains controversial. Here, we present an efficient conservative method to treat ALS.
CASE SUMMARY Case 1 was a 69-year-old male patient who underwent total gastrectomy with Roux-en-Y jejunojejunostomy. On postoperative day (POD) 10 he developed symptoms of ALS that persisted and increased over 1 wk. Case 2 was a 59-year-old male patient who underwent distal gastrectomy with Billroth II gastrojejunostomy. On postoperative day POD 9 he developed symptoms of ALS that persisted for 2 wk. Both patients underwent fluoroscopic-guided nasointestinal tube placement with maintenance of continuous negative pressure suction. Approximately 20 d after the procedure, both patients had recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, there were no signs of ALS in these two patients.
CONCLUSION This is the first report of treating postoperative ALS by fluoroscopic-guided nasointestinal tube placement. Our cases demonstrate that this procedure is an effective and safe method to treat ALS that relieves patients’ symptoms and avoids complications caused by other invasive procedures.
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Affiliation(s)
- Hai-Tao Hu
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fu-Hai Ma
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Zhen-Min Wu
- Department of Oncology, Hebei Petro China Central Hospital, Langfang 065000, Hebei Province, China
| | - Xiu-Heng Qi
- Department of Oncology, Hebei Petro China Central Hospital, Langfang 065000, Hebei Province, China
| | - Yu-Xin Zhong
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yi-Bin Xie
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yan-Tao Tian
- Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Ibrahem Adam RE, Thurley P, Pollock G. Percutaneous transhepatic access to allow per-oral enteric stent insertion for malignant duodenal obstruction following failed endoscopic attempt. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2019. [DOI: 10.18528/ijgii190002a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Peter Thurley
- Department of radiology, Royal Derby Hospital, Derby, UK
| | - Graham Pollock
- Department of radiology, Royal Derby Hospital, Derby, UK
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8
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Cha RR, Cho SB, Kim WS, Kim JJ, Lee JM, Lee SS, Kim HJ, Cho JK. Self-expanding metal stent procedure for afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer: A case report. Medicine (Baltimore) 2018; 97:e13072. [PMID: 30557964 PMCID: PMC6320138 DOI: 10.1097/md.0000000000013072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
RATIONALE Self-expanding metal stent placement is a useful procedure for intestinal obstruction. Afferent loop syndrome after gastrectomy is an uncommon complication of gastroenterostomy reconstruction. Ascending cholangitis caused by afferent loop syndrome is a potential, but rare, complication. PATIENT CONCERNS A 73-year-old man with abdominal pain and vomiting was admitted to the emergency room. His medical history was significant for subtotal gastrectomy with Billroth II anastomosis for benign gastric ulcer perforation 40 years prior. He had notable tenderness to palpation, particularly on the epigastric area, and a temperature of 39.0°C. DIAGNOSIS Abdominal computed tomography revealed afferent loop syndrome with ascending cholangitis caused by remnant gastric cancer. INTERVENTIONS Percutaneous catheter drainage for management of ascending cholangitis was performed on the day of admission. He was subsequently treated with self-expandable metal stent insertion into the stenotic lesion. OUTCOMES After treatment with percutaneous transhepatic insertion of a self-expanding stent, the patient achieved complete resolution of symptoms. The patient died of disease progression 2 months later, without further recurrence of afferent loop syndrome. LESSONS Our case shows that insertion of a metal stent via percutaneous transhepatic biliary drainage (PTBD) can effectively treat ascending cholangitis and resolve afferent loop syndrome in inoperable patients.
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Affiliation(s)
- Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon
- Department of Internal Medicine
| | - Su Beom Cho
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Wan Soo Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon
- Department of Internal Medicine
| | - Jin Joo Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon
- Department of Internal Medicine
| | - Jae Min Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon
- Department of Internal Medicine
| | - Sang Soo Lee
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon
- Department of Internal Medicine
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Changwon
- Department of Internal Medicine
| | - Jin Kyu Cho
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju
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Jinno N, Naitoh I, Nagura Y, Fujioka K, Mizuno Y, Momose J, Ooyama M, Hayashi K, Miyaki T, Nakamura M, Joh T. Percutaneous Transhepatic Self-expanding Metallic Stent Placement for the Treatment of Malignant Afferent Loop Obstruction. Intern Med 2018; 57:333-337. [PMID: 29093418 PMCID: PMC5827311 DOI: 10.2169/internalmedicine.9382-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We report the case of a 71-year-old man with afferent loop obstruction (ALO) after Roux-en-Y reconstruction due to gastric cancer. Computed tomography showed a distended afferent loop and a dilatated bile duct. We could not reach the stricture site in the afferent loop using a gastroscope. We performed percutaneous transhepatic biliary drainage (PTBD) and placed a self-expanding metallic stent (SEMS) in the duodenal stricture through the PTBD route. Although an endoscopic approach is preferable, when PTBD can be performed, percutaneous transhepatic SEMS placement might be an alternative option for treating ALO in cases in which it is not possible to reach the site of stenosis with an endoscope.
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Affiliation(s)
- Naruomi Jinno
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Itaru Naitoh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshihito Nagura
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | | | - Yusuke Mizuno
- Department of Gastroenterology, Nagoya Daini Red Cross Hospital, Japan
| | - Junko Momose
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Makoto Ooyama
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Kazuki Hayashi
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tomokatsu Miyaki
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Makoto Nakamura
- Department of Gastroenterology, Toyokawa Municipal Hospital, Japan
| | - Takashi Joh
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Japan
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10
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Kozarek RA. Endoscopic approaches to afferent and Roux-en-Y limb obstruction. GASTROINTESTINAL INTERVENTION 2016. [DOI: 10.18528/gii150017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Richard A. Kozarek
- Digestive Disease Institute, Virginia Mason Medical Center, Seattle, WA, USA
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11
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Kang EG, Kim C, Lee J, Cha MU, Kim JH, Park SH, Kim MD, Lee DY, Rha SY. Deep vein thrombosis caused by malignant afferent loop obstruction. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.2.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eun Gyu Kang
- Department of Internal Medicine, Hongik Hospital, Seoul, Korea
| | - Chan Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jeungeun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min-uk Cha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Hoon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seo-Hwa Park
- Department of Internal Medicine, Hongik Hospital, Seoul, Korea
| | - Man Deuk Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Do Yun Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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12
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Ratone JP, Caillol F, Bories E, Pesenti C, Godat S, Giovannini M. Hepatogastrostomy by EUS for malignant afferent loop obstruction after duodenopancreatectomy. Endosc Ultrasound 2015; 4:250-2. [PMID: 26374585 PMCID: PMC4568639 DOI: 10.4103/2303-9027.163017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
One of the most difficult biliary drainages is the recurrence and stenosis on afferent loop after surgery. We report an original case of hepaticogastrostomy (HGE) in a patient who had malignant stenosis of afferent loop after cephalic duodenopancreatectomy (CDP). After failure of the gastrointestinal stent, two metal self-expandable stents were placed by endoscopic ultrasound (EUS) after puncture of the dilated left hepatic duct. On clinical improvement and disappearance of jaundice, palliative chemotherapy was started.
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13
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Huang J, Hao S, Yang F, Di Y, Yao L, Li J, Jiang Y, Zhong L, Fu D, Jin C. Endoscopic metal enteral stent placement for malignant afferent loop syndrome after pancreaticoduodenectomy. Wideochir Inne Tech Maloinwazyjne 2015; 10:257-65. [PMID: 26240626 PMCID: PMC4520836 DOI: 10.5114/wiitm.2015.51867] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/22/2014] [Accepted: 03/08/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Afferent loop syndrome (ALS) is a rare and dreaded complication after pancreaticoduodenectomy (PD). Malignant ALS after PD is usually difficult to manage due to patients' poor condition. Effective and safe therapeutic strategies for these patients are reported scarcely at present. AIM To analyze and evaluate the clinical characteristics and treatment of these patients. MATERIAL AND METHODS We analyzed 3 patients with malignant ALS after PD. They were treated by endoscopic enteral metal stent placement in our hospital. Meanwhile we retrospectively reviewed 49 cases with ALS after PD through available English literature. All these patients' clinical features, laboratory study, treatment and outcome were evaluated. RESULTS A total of 52 cases were analyzed in the study. The most common presenting symptoms of ALS after PD were jaundice (56.5%), upper abdominal pain (45.7%), fever (26.1%), and vomiting (23.9%). Sixty percent of ALS cases were caused by tumor recurrence. The mean time from prior surgery to diagnosis of ALS was 13.3 months. The rates of treatment with the endoscopic approach, percutaneous stenting or drainage, surgery, and the conservative method were 40.4%, 32.7%, 11.5%, and 15.4%, respectively. Endoscopic enteral metal stent placement proved more effective and less invasive in the treatment of malignant ALS after PD. CONCLUSIONS Cholangitis and cholangiectasis are the major manifestations of malignant ALS after PD. Invasive interventions are enjoying more and more acceptance for treatment. Endoscopic enteral metal stent placement appears to be a promising technique with effective palliation in these patients.
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Affiliation(s)
- Jiaxin Huang
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Sijie Hao
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Yang
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yang Di
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Lie Yao
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ji Li
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yongjian Jiang
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Zhong
- Department of Gastroenterology, Huashan Hospital, Fudan University, Shanghai, China
| | - Deliang Fu
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Jin
- Department of Pancreatic Surgery, Huashan Hospital, Fudan University, Shanghai, China
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14
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Fujii M, Ishiyama S, Saito H, Ito M, Fujiwara A, Niguma T, Yoshioka M, Shiode J. Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction. World J Gastrointest Endosc 2015; 7:665-669. [PMID: 26078835 PMCID: PMC4461941 DOI: 10.4253/wjge.v7.i6.665] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/19/2014] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Progress in double-balloon endoscopy (DBE) has allowed for the diagnosis and treatment of disease in the postoperative bowel. For example, a short DBE, which has a 2.8 mm working channel and 152 cm working length, is useful for endoscopic retrograde cholangiopancreatography in bowel disease patients. However, afferent loop and Roux-limb obstruction, though rare, is caused by postoperative recurrence of biliary tract cancer with intractable complications. Most of the clinical findings involving these complications are relatively nonspecific and include abdominal pain, nausea, vomiting, fever, and obstructive jaundice. Treatments by surgery, percutaneous transhepatic biliary drainage, percutaneous enteral stent insertion, and endoscopic therapy have been reported. The general conditions of patients with these complications are poor due to cancer progression; therefore, a less invasive treatment is better. We report on the usefulness of metallic stent insertion using an overtube for afferent loop and Roux-limb obstruction caused by postoperative recurrence of biliary tract cancer under short DBE in two patients with complexly reconstructed intestines.
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15
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Sakai A, Shiomi H, Okabe Y, Yagi Y, Kobayashi T, Shiomi Y, Takenaka M, Hoshi N, Arisaka Y, Kutsumi H, Azuma T. Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy. Clin J Gastroenterol 2015; 8:103-7. [PMID: 25708451 DOI: 10.1007/s12328-015-0556-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/08/2015] [Indexed: 12/14/2022]
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.
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Affiliation(s)
- Arata Sakai
- Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan,
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16
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Chhabra P, Singh Rana S, Sharma V, Sharma R, Gupta R, Kumar Bhasin D. An unusual cause of simultaneous common bile and pancreatic duct dilation. Gastroenterol Rep (Oxf) 2014; 3:258-61. [PMID: 24939738 PMCID: PMC4527257 DOI: 10.1093/gastro/gou032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 05/28/2014] [Indexed: 12/28/2022] Open
Abstract
Simultaneous dilation of both the common bile duct and the pancreatic duct (double-duct sign) is usually because of ampullary or pancreatic tumours. Here we report an unusual cause of double-duct dilation; we describe the case of a 49-year-old female who developed afferent loop syndrome after pylorus-preserving pancreaticoduodenectomy: cross-sectional imaging of the abdomen revealed a double-duct sign.
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Affiliation(s)
- Puneet Chhabra
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Ravi Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
| | - Rajesh Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Deepak Kumar Bhasin
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India and
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Bakes D, Cain C, King M, Dong XD(E. Management of afferent loop obstruction from recurrent metastatic pancreatic cancer using a venting gastrojejunostomy. World J Gastrointest Oncol 2013; 5:235-239. [PMID: 24363832 PMCID: PMC3868719 DOI: 10.4251/wjgo.v5.i12.235] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 11/12/2013] [Accepted: 11/19/2013] [Indexed: 02/05/2023] Open
Abstract
Pancreatic cancer is an aggressive malignancy potentially curable with surgical intervention. Following pancreaticoduodenectomy for suspected pancreatic head malignancy, patients have a high risk for both immediate and delayed problems due to surgical complications and recurrent disease. We report here a patient with pancreatic cancer treated with pancreaticoduodenectomy who developed recurrent disease resulting in obstruction of the afferent limb. The patient developed biliary obstruction and cholangitis at presentation. Her biliary tree failed to dilate which precluded safe percutaneous biliary decompression. During surgical exploration, she was found to have a dilated afferent limb at the level of the transverse mesocolon. The patient underwent decompression of the afferent limb as well as the biliary tree using a venting gastrojejunostomy to the blind loop. This represents a novel surgical approach for management of this complicated and difficult problem.
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