Percutaneous Transhepatic Self-expanding Metallic Stent Placement for the Treatment of Malignant Afferent Loop Obstruction

Jinno, Naruomi; Naitoh, Itaru; Nagura, Yoshihito; Fujioka, K.; Mizuno, Yusuke; Momose, Junko; Ooyama, Makoto; Hayashi, Kazuki; Miyaki, Tomokatsu; Nakamura, Makoto; Joh, Takashi

doi:10.2169/internalmedicine.9382-17

Cited by 9 publications

(10 citation statements)

References 15 publications

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“…Bleeding and sepsis have been reported as complications after a PD reoperation. 15 The percutaneous approach is less invasive than open surgery and has been shown to provide effective palliation; 16 , 17 , 18 , 19 however, it is difficult to perform percutaneous transhepatic biliary drainage (PTBD) in patients without intrahepatic bile duct dilation or patients with ascites. PTBD includes causes severe adverse events, such as bleeding, biliary peritonitis, acute cholangitis, frequent catheter dislodgement, and poor quality of life.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy

et al. 2022

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Background Afferent loop obstruction (ALO) is a rare mechanical complication that occurs after gastrojejunostomy. Recently the use of double‐balloon endoscopy (DBE) can be useful for benign and malignant ALO. Methods We retrospectively identified 22 patients who underwent DBE for ALO from January 2009 to December 2020. We evaluated the efficacy and safety of short DBE treatment for ALO. Results Short DBE was able to reach an obstructive site in the afferent limb in all patients (100%) and was able to reach the blind end in 14 patients (64%). The technical success rate was 100%, and the clinical success rate was 95%. Procedure‐related adverse events occurred in two patients (9%). In the case of benign ALO, three of nine patients showed improvement in ALO with single stent placement. Two of nine patients improved after the replacement of the plastic stent (PS) two or three times. Four of nine patients continued with the replacement of PS. In the case of malignant ALO, the metallic stent was placed in 10 patients, and eight patients with metallic stents did not experience stent occlusion until they died. Reintervention was attempted in six patients (27%) with benign ALO but was not attempted in malignant ALO. Conclusions Treatments for ALO using the short DBE was effective and relatively safe because the technical and clinical success rates were very high and there were relatively low complications. Consequently, short DBE could be the first‐choice treatment for both benign and malignant ALO.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy

et al. 2022

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“…This study demonstrated that transhepatic stent placement is an effective treatment for recurrent malignant obstruction in patients with altered bowel anatomy. The technical feasibility of this procedure has been suggested in a few prior studies, including 10 or fewer cases [ 6 7 8 ]. However, to date, its application has been limited to afferent loop obstruction after Billroth II reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…In such patients, the percutaneous transhepatic approach has been used as an alternative technique for successful stent placement [ 6 7 8 ]. However, clinical experiences with transhepatic enteral stent placement have been limited to small case series including less than 10 patients [ 6 7 ]. In addition, prior studies [ 6 7 8 ] exclusively addressed afferent loop obstruction after Billroth II reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…However, clinical experiences with transhepatic enteral stent placement have been limited to small case series including less than 10 patients [ 6 7 ]. In addition, prior studies [ 6 7 8 ] exclusively addressed afferent loop obstruction after Billroth II reconstruction. However, the transhepatic approach has the potential to address more complicated lesions such as concurrent afferent and efferent loop obstruction of gastrojejunostomy (GJ-stomy) and jejunojejunostomy (JJ-stomy).…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery

2021

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Objective To assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy. Materials and Methods Between July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12.0 years) underwent percutaneous transhepatic stent placement for recurrent malignant bowel obstruction after surgery. In all patients, conventional endoscopic peroral stent placement failed due to altered bowel anatomy. The stent was placed with a transhepatic approach for an afferent loop obstruction (n = 27) with a combined transhepatic and peroral approach for simultaneous stent placement in afferent and efferent loop obstruction (n = 9). Technical and clinical success, complications, stent patency, and patient survival were retrospectively evaluated. Results The stent placement was technically successful in all patients. Clinical success was achieved in 30 patients (83.3%). Three patients required re-intervention (balloon dilatation [n = 1] and additional stent placement [n = 2] for insufficient stent expansion). Major complications included transhepatic access-related perihepatic biloma (n = 2), hepatic artery bleeding (n = 2), bowel perforation (n = 1), and sepsis (n = 1). The 3- and 12-months stent patency and patient survival rates were 91.2%, 66.5% and 78.9%, 47.9%, respectively. Conclusion Percutaneous enteral stent placement using transhepatic access for recurrent malignant obstruction in patients with surgically altered bowel anatomy is safe and clinically efficacious. Transhepatic access is a good alternative route for afferent loop obstruction and can be combined with a peroral approach for simultaneous afferent and efferent loop obstruction.

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“…[1] Various etiologies of ALO have been reported, and the treatment differs between malignant and benign etiologies. For patients in whom this syndrome is due to malignant obstruction, less invasive, nonsurgical therapy, such as percutaneous transhepatic biliary drainage (PTBD), percutaneous transhepatic duodenal drainage (PTDD), [2–5] direct percutaneous tube duodenal enterostomy [6] or self-expanding metal stents placement in afferent loop [7,8] is preferred because these patients are in poor condition due to the advanced stage of their malignancy. On the contrary, for patients with benign obstruction, surgical intervention including adhesiolysis, [7] jejunojejunostomy with Braun procedure or Roux-en-Y conversion have been recommended as the choice.…”

Section: Introductionmentioning

confidence: 99%

Endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction after radical gastrectomy for gastric cancer

Cao¹,

Kong

Yang

et al. 2019

Medicine

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Afferent loop obstruction is an uncommon complication associated with Billroth-II distal gastrectomy. Inappropriate treatment may result in life-threatening events as perforation and peritonitis. For the benign afferent loop obstruction, Braun or Roux-en-Y reconstruction has been reported as the choice. However, the edematous afferent loop may result in anastomotic fistula. In this study, a less invasive technique was described for treatment of benign afferent loop obstruction. The aim of this study was to investigate the effectiveness and safety of endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction. We conducted a retrospective review of the data of 2548 gastric cancer patients who underwent distal gastrectomy from January 2002 to January 2018. Patients who developed benign afferent loop obstruction were treated by this procedure. Outcomes were recorded. Follow-up was scheduled at 3, 6, and 12 months after the treatment. Twenty-six patients (1.0%) developed afferent loop obstruction. The median age, consisting of 19 men and 7 women, was 60 years (range 36–69 years). Of these 26 patients, 23 underwent the endoscopic treatment. The obstructive symptoms had a rapid relief in all the 23 patients. No one died due to this procedure. However, 2 patients underwent surgical treatment due to intestinal obstruction because of adhesion at >4 and 7 months after the endoscopic drainage, respectively. Endoscopic nasogastric tube insertion is an effective and safe procedure for treatment of benign afferent loop obstruction. In addition, it could be considered as the first step in treatment, especially in high-surgical-risk patients.

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Percutaneous Transhepatic Self-expanding Metallic Stent Placement for the Treatment of Malignant Afferent Loop Obstruction

Cited by 9 publications

References 15 publications

Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy

Efficacy and safety of endoscopic stent placement for afferent loop obstruction using a short double‐balloon endoscopy

Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery

Endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction after radical gastrectomy for gastric cancer

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