EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage

Bie, Charlotte de; Bronswijk, Michiel; Vanella, Giuseppe; Pérez-Cuadrado-Robles, Enrique; Malenstein, Hannah van; Laleman, Wim; Merwe, Schalk van der

doi:10.1007/s00464-021-08520-z

Cited by 15 publications

(24 citation statements)

References 18 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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“…Table 3 summarizes previous reports concerning EUS-GE for ALS. 9,20,[23][24][25][26][27][28][29][30][31] The reports were identified from the PubMed database for English-language studies using the following keywords: "afferent loop syndrome" and "endo-…”

Section: Clinical Outcomes Of Eus-ge In Patients With Alsmentioning

confidence: 99%

“…Recently, with the advent of LAMSs, favorable data on EUS-GE for ALS have been reported, although the number of reports is limited. 9,23,24,[26][27][28][29]31 Furthermore, the availability of EC-LAMSs has enabled single-step deployment, and EUS-GE has become a simpler and safer procedure. EUS-GE has the advantage of ensuring long-term stent patency because it does not involve crossing the stricture of the afferent limbs, allowing for continuous effective chemotherapy, which is expected to prolong survival.…”

Section: Future Perspectivesmentioning

confidence: 99%

“…Bie et al [ 28 ] conducted a retrospective comparative study between PTD and EUS-guided drainage, including EUS-GE and EUS-guided hepaticogastrostomy (EUS-HGS) for malignant ALS. Their study included 17 patients, five of whom underwent PTD, six underwent EUS-GE, and six underwent EUS-HGS.…”

Section: Afferent Loop Syndromementioning

confidence: 99%

“…However, recent reports have shown that patients with mild or localized ascites could be considered for EUS-GE without risking leakage or peritonitis if the ascites does not interfere with the drainage route. Therefore, the presence of ascites should not be considered a strict contraindication for EUS-GE, except for massive ascites [ 9 , 28 ]. Despite limited evidence, we believe that EUS-GE should be the first choice of treatment for ALS if the distance between the dilated afferent limbs and the stomach is close and if there is no intervening ascites based on the results of previous reports [ 9 , 28 ].…”

Section: Afferent Loop Syndromementioning

confidence: 99%

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Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome

et al. 2021

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Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.

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Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review

Yamamoto,

Itoi,

Matsunami

et al. 2023

J Hepato Biliary Pancreat

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Background/PurposeAfferent loop syndrome (ALS) is a rare adverse event after gastrointestinal surgery requiring appropriate early decompression treatment. Several endoscopic interventions have been attempted for treatment, including endoscopic enteral metal stent placement (EMSP), endoscopic ultrasound (EUS)‐guided entero‐enterostomy (EUS‐EE), and EUS‐guided hepaticogastrostomy (EUS‐HGS). However, there are limited data on outcomes, including duration of stent patency. In this study, we evaluated the usefulness of each endoscopic intervention for malignant ALS.MethodsWe retrospectively investigated nine patients with malignant ALS who underwent EMSP, EUS‐EE, or EUS‐HGS. Information on technical success, clinical efficacy, adverse events, stent dysfunction, and overall survival was collected and analyzed.ResultsThe most common symptoms were abdominal pain and cholangitis. ALS was treated by EMSP in three patients, EUS‐EE in three patients, and EUS‐HGS in three patients. Stent placement was successful and clinically effective in all patients with no adverse events. During follow‐up, stent dysfunction occurred in two patients treated by EUS‐HGS. Eight patients died of primary disease during a median follow‐up of 157 days.ConclusionsEach of the available endoscopic interventions for malignant ALS can be expected to produce similar outcomes, including duration of stent patency. The choice of endoscopic intervention should be made based on the characteristics of each treatment.

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EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage

Cited by 15 publications

References 18 publications

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

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

Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome

Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review

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