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Case Reports
, 27 (4), 413-417

Enteral Stenting for Gastric Outlet Obstruction and Afferent Limb Syndrome Following Pancreaticoduodenectomy

Case Reports

Enteral Stenting for Gastric Outlet Obstruction and Afferent Limb Syndrome Following Pancreaticoduodenectomy

Wilson T Kwong et al. Ann Gastroenterol.


Background: Obstruction of the afferent or efferent limbs of a gastrojejunal anastomosis is a potential complication after pancreaticoduodenectomy (PD) resulting in either gastric outlet obstruction or afferent limb syndrome. The use of self-expanding metal stents for the management of anastomotic strictures after resection of pancreatic cancer has not been well studied. We present four such cases and review published data regarding this population.

Methods: Retrospective chart review and literature search. Outcomes were summarized with descriptive statistics.

Results: At our institution, 4 patients underwent metal stent placement for gastrojejunal obstruction after PD for pancreatic cancer. Enteral stents were placed in two patients across the afferent limb, in one patient across the efferent limb, and in another patient across both limbs. Similar cases in the literature revealed that the anastomotic stricture was malignant in 26 of 27 cases. Clinical improvement occurred in 88%. Afferent limb syndrome was successfully treated in 5 of 6 cases. Median survival was 3.5 months after stent placement.

Conclusions: Effective palliation of both gastric outlet obstruction and afferent limb syndrome after PD can be provided with enteral stenting. Gastrojejunal strictures after PD for pancreatic cancer are usually malignant with median survival of 3.5 months after stent placement.

Keywords: Stent; afferent limb syndrome; gastric outlet obstruction; pancreatic cancer; pancreaticoduodenectomy.

Conflict of interest statement

Conflict of Interest: None


Figure 1
Figure 1
Tight angulation of the efferent limb of a gastrojejunal anastomosis. A catheter is successfully passed across the angulation
Figure 2
Figure 2
Positron emission tomography computed tomography scan demonstrating malignant recurrence surrounding an efferent limb stent
Figure 3
Figure 3
Fluoroscopy image demonstrating placement of an afferent limb stent alongside an efferent limb stent in a patient with both afferent and efferent limb obstruction
Figure 4
Figure 4
A metal stent in the afferent limb and three metal stents in the efferent limb in a patient with afferent loop syndrome and recurrent malignant obstruction of the efferent limb

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Cited by 4 PubMed Central articles


    1. Oida T, Mimatsu K, Kano H, et al. Palliative enteric bypass for malignant gastric outflow obstruction after pancreaticoduodenectomy in early recurrent pancreatic cancer. Hepatogastroenterology. 2011;58:1360–1367. - PubMed
    1. Pannala R, Brandabur JJ, Gan SI, et al. Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer:single-center, 14-year experience. Gastrointest Endosc. 2011;74:295–302. - PubMed
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