Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction

Abstract The usefulness of endoscopic ultrasound (EUS)‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent (LAMS) has been reported. However, LAMS is not available in many countries and is more expensive than a conventional fully covered self‐expandable metal stent (FCSEMS). We trea...

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Autores principales:	Koichiro Mandai, Koji Uno, Kenjiro Yasuda
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	afferent loop obstruction afferent loop syndrome endoscopic ultrasound gastrojejunostomy stent Diseases of the digestive system. Gastroenterology RC799-869
Acceso en línea:	https://doaj.org/article/302916117c7347668c7fef19fceb0e78
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spelling	oai:doaj.org-article:302916117c7347668c7fef19fceb0e782021-11-16T19:20:28ZEndoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction2692-460910.1002/deo2.3https://doaj.org/article/302916117c7347668c7fef19fceb0e782021-04-01T00:00:00Zhttps://doi.org/10.1002/deo2.3https://doaj.org/toc/2692-4609Abstract The usefulness of endoscopic ultrasound (EUS)‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent (LAMS) has been reported. However, LAMS is not available in many countries and is more expensive than a conventional fully covered self‐expandable metal stent (FCSEMS). We treated cases of malignant afferent loop obstruction after Roux‐en‐Y reconstruction: three patients underwent EUS‐guided hepaticoenterostomy (EUS‐HES) and one patient underwent EUS‐GJ with a conventional biliary FCSEMS, instead of EUS‐GJ with a LAMS. In two of the cases, EUS‐GJ or EUS‐guided jejunojejunostomy was not indicated because the afferent loop was far from the stomach or jejunum, and EUS‐HES was performed. In one case, in which both EUS‐HES and EUS‐GJ were feasible, EUS‐HES was performed because of unavailability of LAMS for EUS‐GJ in Japan. In another case, EUS‐HES was not indicated because of massive ascites around the liver, and thus, EUS‐GJ using a 10 mm FCSEMS combined with a 7 Fr large‐loop double‐pigtail plastic stent was performed. In all four cases, the patients’ symptoms improved without any adverse events. Stent occlusion did not occur in three of the four cases until the patients died of advanced cancer progression. EUS‐GJ using a 10 mm FCSEMS with a 7 Fr large‐loop double‐pigtail plastic stent or EUS‐HES is likely safe and effective for managing malignant afferent loop obstruction.Koichiro MandaiKoji UnoKenjiro YasudaWileyarticleafferent loop obstructionafferent loop syndromeendoscopic ultrasoundgastrojejunostomystentDiseases of the digestive system. GastroenterologyRC799-869ENDEN Open, Vol 1, Iss 1, Pp n/a-n/a (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	afferent loop obstruction afferent loop syndrome endoscopic ultrasound gastrojejunostomy stent Diseases of the digestive system. Gastroenterology RC799-869
spellingShingle	afferent loop obstruction afferent loop syndrome endoscopic ultrasound gastrojejunostomy stent Diseases of the digestive system. Gastroenterology RC799-869 Koichiro Mandai Koji Uno Kenjiro Yasuda Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction
description	Abstract The usefulness of endoscopic ultrasound (EUS)‐guided gastrojejunostomy (EUS‐GJ) using a lumen‐apposing metal stent (LAMS) has been reported. However, LAMS is not available in many countries and is more expensive than a conventional fully covered self‐expandable metal stent (FCSEMS). We treated cases of malignant afferent loop obstruction after Roux‐en‐Y reconstruction: three patients underwent EUS‐guided hepaticoenterostomy (EUS‐HES) and one patient underwent EUS‐GJ with a conventional biliary FCSEMS, instead of EUS‐GJ with a LAMS. In two of the cases, EUS‐GJ or EUS‐guided jejunojejunostomy was not indicated because the afferent loop was far from the stomach or jejunum, and EUS‐HES was performed. In one case, in which both EUS‐HES and EUS‐GJ were feasible, EUS‐HES was performed because of unavailability of LAMS for EUS‐GJ in Japan. In another case, EUS‐HES was not indicated because of massive ascites around the liver, and thus, EUS‐GJ using a 10 mm FCSEMS combined with a 7 Fr large‐loop double‐pigtail plastic stent was performed. In all four cases, the patients’ symptoms improved without any adverse events. Stent occlusion did not occur in three of the four cases until the patients died of advanced cancer progression. EUS‐GJ using a 10 mm FCSEMS with a 7 Fr large‐loop double‐pigtail plastic stent or EUS‐HES is likely safe and effective for managing malignant afferent loop obstruction.
format	article
author	Koichiro Mandai Koji Uno Kenjiro Yasuda
author_facet	Koichiro Mandai Koji Uno Kenjiro Yasuda
author_sort	Koichiro Mandai
title	Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction
title_short	Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction
title_full	Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction
title_fullStr	Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction
title_full_unstemmed	Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction
title_sort	endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after roux‐en‐y reconstruction
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/302916117c7347668c7fef19fceb0e78
work_keys_str_mv	AT koichiromandai endoscopicultrasoundguidedtreatmentformalignantafferentloopobstructionafterrouxenyreconstruction AT kojiuno endoscopicultrasoundguidedtreatmentformalignantafferentloopobstructionafterrouxenyreconstruction AT kenjiroyasuda endoscopicultrasoundguidedtreatmentformalignantafferentloopobstructionafterrouxenyreconstruction
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Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction

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