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

Endoscopy. 2018 Sep;50(9):891-895. doi: 10.1055/s-0044-102254. Epub 2018 Mar 2.

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.

Publication types

  • Multicenter Study

MeSH terms

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