The Role of Endoscopic Management in Afferent Loop Syndrome

Abstract

Afferent loop syndrome (ALS) is a morbid complication that may occur after gastrectomy and gastrojejunostomy reconstruction. The aim of this article is to review the different endoscopic treatment options of ALS. We describe the evolution of the endoscopic treatment of ALS and its limitations despite the overall propitious profile. We analyze the advantages of endoscopic ultrasound-guided entero-enterostomy (EUS EE) over enteroscopy-guided intervention, and the clinical outcomes of EUS EE. We expound on pre-procedural considerations, intra-procedural techniques and post-procedural care following EUS EE. We conclude that given the simplification of the technique and the ability to place a stent away from the tumor, EUS EE is a promising technique that will likely be established as the treatment of choice for ALS.

Endoscopic recanalization of an occluded Braun anastomosis using an endoscopic injection needle

“…1 Occlusion of a Braun anastomosis can lead to ALS, posing a risk of nonobstructive cholangitis. 2 In such circumstances, surgical reconstruction is highly invasive, and although endoscopic ultrasonography (EUS)-guided enterostomy offers a less invasive alternative, 3,4 challenging cases still exist. We hereby report the safer endoscopic recanalization for an occluded Braun anastomosis using an endoscopic needle (Video S1).…”

Combined endoscopic drainage for afferent loop obstruction and bilioenteric anastomosis stricture in a patient after pancreatoduodenectomy

“…Tumor recurrence is a common cause of bilioenteric anastomosis stricture or afferent loop obstruction (ALO) in patients who have undergone pancreaticoduodenectomy. Endoscopic management in ALO included enteroscopy-assisted luminal stenting with a self-expanding metal stent or plastic stents and endoscopic ultrasound (EUS)-guided enteroenterostomy with a lumen-apposing metal stent [1,2]. In addition, the bridge technique for drainage of the right liver across the left liver through hepaticogastrostomy (HGS) is feasible [3,4].…”