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 Table of Contents  
Year : 2018  |  Volume : 7  |  Issue : 6  |  Page : 418-419

EUS-guided gastroenterostomy for afferent loop syndrome treatment stent

Division of Gastroenterology, Paoli-Calmettes Institute, Marseille, France

Date of Submission12-Jan-2017
Date of Acceptance22-May-2017
Date of Web Publication12-Jul-2018

Correspondence Address:
Dr. Dina Chaaro Benallal
Hospital Universitario Virgen Macarena, Seville, Spain

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/eus.eus_41_17

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How to cite this article:
Benallal DC, Hoibian S, Caillol F, Bories E, Presenti C, Ratone JP, Giovannini M. EUS-guided gastroenterostomy for afferent loop syndrome treatment stent. Endosc Ultrasound 2018;7:418-9

How to cite this URL:
Benallal DC, Hoibian S, Caillol F, Bories E, Presenti C, Ratone JP, Giovannini M. EUS-guided gastroenterostomy for afferent loop syndrome treatment stent. Endosc Ultrasound [serial online] 2018 [cited 2019 Aug 18];7:418-9. Available from: http://www.eusjournal.com/text.asp?2018/7/6/418/236555

Afferent loop syndrome is a known complication of pancreaticoduodenectomy. The incidence may be as high as 13%, and survival of 3years or longer is the only factor associated with its development.[1] Surgical, percutaneous, and endoscopic treatments of afferent loop syndrome have been described, but such treatments are not always feasible. Successful treatment through EUS–guided hepaticogastrostomy has also been reported by our group.[2] We herein present a video case of EUS-guided gastroenterostomy for afferent loop syndrome treatment with SPAXUS® stent (Taewong Medical, Gyeonggi-do, SouthKorea).

An 80-year-old man, who had undergone Whipple surgery in 2012 for pancreatic adenocarcinoma, was referred for abdominal pain and fever associated with bile duct and afferent loop dilation. Anodule of carcinomatosis localized in the gastrojejunal anastomosis, which was causing the obstruction, was punctured, and carcinoma relapse was histologically confirmed[Figure 1] and [Figure 2].
Figure1: Nodule of carcinomatosis localized in the gastrojejunal anastomosis

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Figure2: Nodule of carcinomatosis and dilated afferent loop

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Transgastric puncture of the dilated afferent loop was performed with a 10-Fr Cystotome™ (Cook Medical Ireland, Limrick, Ireland)). Contrast was injected for fluoroscopic viewing of limb and bile duct dilatation[Figure3]. The incision was enlarged with the 10-Fr Cystotome after insertion of a 0.035-inch guidewire(G-FLEX®, Nivelles, Belgium). A2-cm-long×16-mm-diameter ASPAXUS® stent(TaeWoong Medical, Gyeonggi-do, SouthKorea) was deployed under fluoroscopic view. An 8-mm Hurricane dilatation balloon(Boston Scientific Corp, MA, USA) was then used to dilate the tract within the lumen of the NTI-S™ SPAXUS® stent (Taewong Medical, Gyeonggi-do, SouthKorea), and a 7-cm×7-Fr pigtail stent was inserted within the stent to prevent migration[Figure4].
Figure3: Fluoroscopic view: Limb and bile duct dilatation

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Figure4: Fluoroscopic view: 7-cm×7-Fr pigtail stent within SPAXUS® stent

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No serious complication was reported after the procedure, except for abdominal pain, which was managed with analgesic. The patient was discharged 4days after the procedure. The patient died 3months after the procedure because of disease progression.

EUS-guided treatment of afferent loop syndrome has been reported using transgastric plastic stent insertion,[3] metallic stent(NAGY and AXIOS),[4],[5] and also hepaticogastrostomy,[2] as we have already mentioned.

To our knowledge, this is thefirst reported case of treatment with the SPAXUS® stent. EUS-guided gastroenterostomy in this clinical case was performed safely and efficiently, but larger series is needed to evaluate the procedure.

Patient informed consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initial will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This work was not supported by any funding sources, grants, or sponsorships.

Conflicts of interest

There are no conflicts of interest.

  References Top

PannalaR, BrandaburJJ, GanSI, etal. Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: Single-center, 14-year experience. Gastrointest Endosc 2011;74:295-302.  Back to cited text no. 1
RatoneJP, CaillolF, BoriesE, etal. Hepatogastrostomy by EUS for malignant afferent loop obstruction after duodenopancreatectomy. Endosc Ultrasound 2015;4:250-2.  Back to cited text no. 2
MatsumotoK, KatoH, TomodaT, etal. Acase of acute afferent loop syndrome treated by transgastric drainage with EUS. Gastrointest Endosc 2013;77:132-3.  Back to cited text no. 3
ShahA, KhannaL, SethiA. Treatment of afferent limb syndrome: Novel approach with endoscopic ultrasound-guided creation of a gastrojejunostomy fistula and placement of lumen-apposing stent. Endoscopy 2015;47Suppl1:E309-10.  Back to cited text no. 4
ChowdhurySD, KurienRT, BharathAK, etal. Endoscopic ultrasound-guided gastrojejunostomy with a Nagi stent for relief of jejunal loop obstruction following hepaticojejunostomy. Endoscopy 2016;48Suppl1:E263-4.  Back to cited text no. 5


  [Figure 1], [Figure 2], [Figure3], [Figure4]


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