1
|
Ito T, Shimatani M, Masuda M, Nakamaru K, Mitsuyama T, Fukata N, Ikeura T, Takaoka M, Okazaki K, Naganuma M. Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy. DEN OPEN 2023; 3:e154. [PMID: 35898829 PMCID: PMC9307746 DOI: 10.1002/deo2.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Takashi Ito
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Masaaki Shimatani
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
- Division of Gastroenterology and Hepatology Kansai Medical University Medical Center Osaka Japan
| | - Masataka Masuda
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Koh Nakamaru
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Toshiyuki Mitsuyama
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
- Division of Gastroenterology and Hepatology Kansai Medical University Medical Center Osaka Japan
| | - Norimasa Fukata
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Tsukasa Ikeura
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Makoto Takaoka
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| | - Kazuichi Okazaki
- Department of Internal Medicine Kansai Medical University Kori Hospital Osaka Osaka Japan
| | - Makoto Naganuma
- The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan
| |
Collapse
|
2
|
Satoh T, Ishiwatari H, Ishikawa K, Kimura H, Matsubayashi H, Ono H. Simultaneous stent placement for biliary and afferent loop obstruction due to tumor recurrence after pancreatoduodenectomy. Endoscopy 2022; 54:E524-E525. [PMID: 34695847 DOI: 10.1055/a-1662-4433] [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: 12/10/2022]
Affiliation(s)
- Tatsunori Satoh
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Kazuma Ishikawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hidenori Kimura
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| |
Collapse
|
3
|
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
| |
Collapse
|
4
|
Wang C, Niu H, Yang C, Liu J, Wang Y, Ju S, Bai Y, Ren J, Xiong B. Covered vs. uncovered self-expandable metal stents for palliation of malignant afferent loop obstruction: a multicenter study. Scand J Gastroenterol 2022; 57:364-370. [PMID: 34842020 DOI: 10.1080/00365521.2021.2009023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Endoscopic stent placement is a palliative therapy for malignant digestive tract obstruction. However, its use for malignant afferent loop obstruction (mALO) has not been adequately investigated. METHODS From March 2009 to December 2020, 137 patients with mALO who underwent endoscopic stent placement at three tertiary care centers were retrospectively enrolled. The primary aim of this study was to compare stent dysfunction (SD) between the covered self-expandable metal stent (CSEMS) and uncovered self-expandable metal stent (UCSEMS) groups, with subgroup analysis among patients with extrinsic and intrinsic tumors separately. RESULTS Twenty-three patients developed SD in the CSEMS group and 29 patients in the UCSEMS group (log-rank p = .974). The primary contributors to SD included a higher risk of stent migration in the CSEMS group and stent ingrowth in the UCSEMS group (p = .003; p < .001). Among patients with extrinsic tumors, the CSEMS group showed a significantly higher probability of overall SD (p = .008) and stent migration (p = .001) with a shorter time to SD (log-rank p = .006) than the UCSEMS group. Among patients with intrinsic tumors, the CSEMS group showed a significantly lower incidence of overall SD (p < .001) and stent ingrowth (p < .001) with a longer time to SD (log-rank p = .011) than the UCSEMS group. CONCLUSIONS Our results showed no significant difference in SD between the CSEMS and UCSEMS groups for palliation of mALO. Furthermore, subgroup analysis suggested using CSEMSs for patients with intrinsic tumors, and UCSEMSs for those with extrinsic tumors.
Collapse
Affiliation(s)
- Chaoyang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huanzhang Niu
- Department of Interventional Radiology, The First Affiliated Hospital, Henan University of Science and Technology, Luoyang, China
| | - Chongtu Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Shuguang Ju
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jianzhuang Ren
- Department of Interventional Radiology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| |
Collapse
|
5
|
Mandai K, Uno K, Yasuda K. Endoscopic ultrasound‐guided treatment for malignant afferent loop obstruction after Roux‐en‐Y reconstruction. DEN OPEN 2021; 1:e3. [PMID: 35310154 PMCID: PMC8828209 DOI: 10.1002/deo2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/25/2020] [Accepted: 01/05/2021] [Indexed: 12/05/2022]
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.
Collapse
Affiliation(s)
- Koichiro Mandai
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Koji Uno
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| | - Kenjiro Yasuda
- Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan
| |
Collapse
|
6
|
Abstract
Afferent loop syndrome (ALS) is a mechanical complication that arises after gastric surgery with gastrojejunostomy reconstruction. This condition was first described in 1950 by Roux, Pedoussaut, and Marchal to post-gastrectomy patients with bilious vomiting. Acute ALS is associated with complete obstruction and considered a surgical emergency, whereas chronic ALS is mostly related to partial obstruction of the afferent loop. The delay in diagnosis may lead to intestinal ischemia, perforation and can be associated with a high mortality rate up to 60%. Surgery is usually the mainstay treatment of ALS, but endoscopic therapy, including stent placement in malignancy-related, anastomotic stricture dilation, has been evolving over the past recent years.
Collapse
|