Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience.

Abstract

BACKGROUND:

Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE.

METHODS:

This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected.

RESULTS:

18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P < 0.001).

CONCLUSION:

EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.

• Authors: Olaya I Brewer Gutierrez, Shayan S Irani, Saowanee Ngamruengphong, Hanaa D Aridi, Rastislav Kunda, Ali Siddiqui, Markus Dollhopf, Jose Nieto, Yen-I Chen, Nadav Sahar, Majidah A Bukhari, Omid Sanaei, Marcia I Canto, Vikesh K Singh, Richard Kozarek, Mouen A Khashab
• Journal: Endoscopy (Endoscopy) Vol. 50 Issue 9 Pg. 891-895 (09 2018) ISSN: 1438-8812 [Electronic] Germany
• PMID: 29499577 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © Georg Thieme Verlag KG Stuttgart · New York.

Topics

• Afferent Loop Syndrome (epidemiology, etiology, physiopathology, surgery)
• Endosonography (methods)
• Enterostomy (adverse effects, instrumentation, methods)
• Female
• Humans
• Jaundice (diagnosis, etiology)
• Male
• Middle Aged
• Outcome and Process Assessment, Health Care
• Pancreaticoduodenectomy (adverse effects)
• Postoperative Complications (diagnosis, epidemiology, surgery)
• Reoperation (methods, statistics & numerical data)
• Retrospective Studies
• Stents
• Symptom Assessment (methods, statistics & numerical data)
• Treatment Outcome
• United States (epidemiology)
• Vomiting (diagnosis, etiology)