Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single-center experience and literature review

IF 3.2 3区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Journal of Hepato‐Biliary‐Pancreatic Sciences Pub Date : 2023-10-31 DOI:10.1002/jhbp.1380
Kenjiro Yamamoto, Takao Itoi, Yukitoshi Matsunami, Atsushi Sofuni, Takayoshi Tsuchiya, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Ryosuke Nakatsubo, Ryosuke Tonozuka
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Abstract

Background/Purpose

Afferent loop syndrome (ALS) is a rare adverse event after gastrointestinal surgery requiring appropriate early decompression treatment. Several endoscopic interventions have been attempted for treatment, including endoscopic enteral metal stent placement (EMSP), endoscopic ultrasound (EUS)-guided entero-enterostomy (EUS-EE), and EUS-guided hepaticogastrostomy (EUS-HGS). However, there are limited data on outcomes, including duration of stent patency. In this study, we evaluated the usefulness of each endoscopic intervention for malignant ALS.

Methods

We retrospectively investigated nine patients with malignant ALS who underwent EMSP, EUS-EE, or EUS-HGS. Information on technical success, clinical efficacy, adverse events, stent dysfunction, and overall survival was collected and analyzed.

Results

The most common symptoms were abdominal pain and cholangitis. ALS was treated by EMSP in three patients, EUS-EE in three patients, and EUS-HGS in three patients. Stent placement was successful and clinically effective in all patients with no adverse events. During follow-up, stent dysfunction occurred in two patients treated by EUS-HGS. Eight patients died of primary disease during a median follow-up of 157 days.

Conclusions

Each of the available endoscopic interventions for malignant ALS can be expected to produce similar outcomes, including duration of stent patency. The choice of endoscopic intervention should be made based on the characteristics of each treatment.

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内镜介入治疗恶性传入环综合征患者的早期和晚期效果:单中心经验和文献综述。
背景/目的:传入环综合征(ALS)是胃肠道手术后一种罕见的不良事件,需要适当的早期减压治疗。已经尝试了几种内窥镜干预措施进行治疗,包括内窥镜肠内金属支架置入术(EMSP)、内窥镜超声(EUS)引导的肠造口术(EUS-EE)和EUS引导的肝胃造口术(EUS-HGS)。然而,关于结果的数据有限,包括支架通畅的持续时间。在本研究中,我们评估了每种内镜干预对恶性ALS的有效性。方法:我们回顾性调查了9例接受EMSP、EUS-EE或EUS-HGS的恶性ALS患者。收集并分析有关技术成功率、临床疗效、不良事件、支架功能障碍和总生存率的信息。结果:最常见的症状是腹痛和胆管炎。三名ALS患者接受EMSP治疗,三名患者接受EUS-EE治疗,三例患者接受EUS-HGS治疗。支架置入成功且临床有效,所有患者均无不良事件发生。在随访期间,两名接受EUS-HGS治疗的患者出现支架功能障碍。中位随访157例,8例患者死于原发性疾病 天。结论:每种治疗恶性ALS的内镜干预措施都有望产生相似的结果,包括支架通畅的持续时间。应根据每种治疗的特点选择内镜介入治疗。
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来源期刊
Journal of Hepato‐Biliary‐Pancreatic Sciences
Journal of Hepato‐Biliary‐Pancreatic Sciences GASTROENTEROLOGY & HEPATOLOGY-SURGERY
自引率
10.00%
发文量
178
审稿时长
6-12 weeks
期刊介绍: The Journal of Hepato-Biliary-Pancreatic Sciences (JHBPS) is the leading peer-reviewed journal in the field of hepato-biliary-pancreatic sciences. JHBPS publishes articles dealing with clinical research as well as translational research on all aspects of this field. Coverage includes Original Article, Review Article, Images of Interest, Rapid Communication and an announcement section. Letters to the Editor and comments on the journal’s policies or content are also included. JHBPS welcomes submissions from surgeons, physicians, endoscopists, radiologists, oncologists, and pathologists.
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