521 results match your criteria Afferent Loop Syndrome


EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage.

Surg Endosc 2021 Apr 28. Epub 2021 Apr 28.

Department of Gastroenterology and Hepatology, University Hospitals Gasthuisberg, University of Leuven, Herestraat 49, 3000, Leuven, Belgium.

Objectives: Where palliative surgery or percutaneous drainage used to be the only option in patients with afferent loop syndrome, endoscopic management by EUS-guided gastroenterostomy has been gaining ground. However, EUS-guided hepaticogastrostomy might also provide sufficient biliary drainage. Our aim was to evaluate the feasibility of EUS-guided hepaticogastrostomy for the management of afferent loop syndrome and provide comparative data on the different approaches. Read More

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Endoscopic ultrasonography (EUS) -guided visceral anastomoses: indications and techniques.

Minerva Gastroenterol (Torino) 2021 Apr 1. Epub 2021 Apr 1.

Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele-Giuseppe Giglio, Cefalù, Palermo, Italy.

Background: Technologic advancements in the field of therapeutic endoscopy have led to the development of minimally invasive techniques to create gastrointestinal anastomosis instead of surgical interventions. Examples of the potential clinical applications include bypassing malignant and benign gastric outlet obstruction, providing access to the pancreato-biliary tree in those who have undergone Roux-en-Y gastric bypass, and relieving pancreato-biliary symptoms in afferent loop syndrome.

Methods: starting from the available literature, aim of this narrative review is to summarize indications and techniques of endoscopic ultrasonography-guided visceral anastomoses. Read More

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Percutaneous Enteral Stent Placement Using a Transhepatic Access for Palliation of Malignant Bowel Obstruction after Surgery.

Korean J Radiol 2021 05 29;22(5):742-750. Epub 2021 Jan 29.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

Objective: To assess the safety and clinical efficacy of percutaneous transhepatic enteral stent placement for recurrent malignant obstruction in patients with surgically altered bowel anatomy.

Materials And Methods: Between July 2009 and May 2019, 36 patients (27 men and 9 women; mean age, 62.7 ± 12. Read More

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Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports.

World J Clin Cases 2020 Nov;8(21):5353-5360

Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.

Background: Afferent loop syndrome (ALS) is a rare mechanical complication that occurs after reconstruction of the stomach or esophagus to the jejunum, such as Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagoje-junostomy. Traditionally, an operation is the first choice for benign causes. However, for patients in poor physical condition who experience ALS soon after R0 resection, the type of treatment remains controversial. Read More

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November 2020

Reconstruction of the esophagus of patients with middle thoracic esophageal carcinoma using the remnant stomach following Billroth II gastrectomy.

Dis Esophagus 2021 Jan;34(1)

Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China.

It seems impossible to reconstruct the esophagus of patients with middle thoracic esophageal carcinoma with a history of distal gastrectomy using the remnant stomach. Although surgeons have made multiple efforts to reconstruct the esophagus using the remnant stomach, it can only be successfully used in cases of lower thoracic esophageal cancer. Additionally, the surgery is more complex than traditional esophagogastrostomy due to challenges including mobilization of the remnant stomach with the spleen and transposition of the pancreatic tail into the left hemithorax. Read More

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January 2021

Afferent Loop Syndrome with Intestinal Ischemia due to Internal Hernia after Whipple Operation for T2N1M0 Pancreatic Cancer.

J Clin Imaging Sci 2020 24;10:43. Epub 2020 Jul 24.

Department of Radiology, H. Lee Moffitt Cancer Center, 12902 USF Magnolia Dr, Tampa, Florida, United States.

Afferent loop syndrome is an uncommon complication of Whipple procedure. The often vague and non-specific presentation results in difficulty and/or delay in diagnosis, which may lead to bowel ischemia or perforation. CT can demonstrate characteristic features, yield the diagnosis of afferent loop syndrome, and predict the cause before surgical intervention. Read More

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Diagnosis and treatment of the afferent loop syndrome.

Clin J Gastroenterol 2020 Oct 8;13(5):660-668. Epub 2020 Jul 8.

Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand.

Afferent loop syndrome (ALS) is a mechanical complication that arises after gastric surgery with gastrojejunostomy reconstruction. This condition was first described in 1950 by Roux, Pedoussaut, and Marchal to post-gastrectomy patients with bilious vomiting. Acute ALS is associated with complete obstruction and considered a surgical emergency, whereas chronic ALS is mostly related to partial obstruction of the afferent loop. Read More

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October 2020

Endoscopic gastrointestinal anastomosis: a review of established techniques.

Gastrointest Endosc 2021 01 25;93(1):34-46. Epub 2020 Jun 25.

Division of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.

Technologic advancements in the field of therapeutic endoscopy have led to the development of minimally invasive techniques to create GI anastomosis without requiring surgery. Examples of the potential clinical applications include bypassing malignant and benign gastric outlet obstruction, providing access to the pancreatobiliary tree in those who have undergone Roux-en-Y gastric bypass, and relieving pancreatobiliary symptoms in afferent loop syndrome. Endoscopic GI anastomosis is less invasive and less expensive than surgical approaches, result in improved outcomes, and therefore are more appealing to patients and providers. Read More

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January 2021

König's Syndrome After Roux-en-Y Gastric Bypass: Candy Cane Twist.

Obes Surg 2020 Aug;30(8):3251-3252

Department of General and Digestive Surgery, Bariatric Surgery Unit, Poissy Saint Germain-en-laye, Saint Germain-en-laye, France.

Background: A König's syndrome is referred to abdominal pain in relation to meals with constipation alternated with diarrhea, meteorism, and abdominal distension. A postoperative long-term complication after Roux-en-Y gastric bypass could be the appearance of chronic abdominal pain associated with vomiting, dysphagia, and nausea.

Case Report: A 43-year-old female patient was submitted for a Roux-en-Y gastric bypass for morbid obesity with an initial body mass index (BMI) of 36 kg/m (weight 100 kg, height 168 cm). Read More

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A "Kissing-Stents" Technique in the Management of Afferent Limb Syndrome With Concomitant Efferent Limb Obstruction in a Patient With Gastric Cancer and Billroth II Anatomy.

ACG Case Rep J 2020 Jan 7;7(1):e00266. Epub 2020 Jan 7.

Department of Medicine, Harvard Medical School, Boston, MA.

The "kissing-stents" technique has been used in endovascular interventions for the management of aortic and arterial stenosis at bifurcation sites. However, to our knowledge, the use of this technique to prevent stent migration in endoscopy has not been described to date. We present a 65-year-old man with metastatic gastric adenocarcinoma status post-Billroth II gastrojejunostomy complicated by simultaneous afferent and efferent limb syndrome with gastric outlet obstruction and biliary dilatation. Read More

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January 2020

Single-step EUS-guided jejunojejunostomy with a lumen-apposing metal stent as treatment for malignant afferent limb syndrome.

VideoGIE 2020 Apr 6;5(4):154-156. Epub 2020 Feb 6.

Endoscopy Service, Department of Diagnostic and Therapeutic Services, Istituto Mediterraneo per i Trapianti e Terapie ad alta Specializzazione, Palermo, Italy.

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Lower peripouch fat area is related with increased frequency of pouch prolapse and floppy pouch complex in inflammatory bowel disease patients.

Int J Colorectal Dis 2020 Apr 4;35(4):665-674. Epub 2020 Feb 4.

Department of Colorectal Surgery, The Cleveland Clinic Foundation, Cleveland, OH, USA.

Background: Pouch prolapse is a rare pouch complication which often leads to pouch failure in inflammatory bowel disease (IBD) patients. Its exact cause remains unknown. Floppy pouch complex (FPC) was defined as the presence of any one of the following pouch disorders: pouch prolapse, afferent limb syndrome (ALS), redundant loop, and pouch folding. Read More

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Management of afferent loop syndrome after Roux-en-Y subtotal gastrectomy and choledocolithiasis with recurrent cholangitis.

BMJ Case Rep 2020 Jan 5;13(1). Epub 2020 Jan 5.

General Surgery, Hospital and University Centre of Coimbra, Coimbra, Portugal.

Afferent loop syndrome is a rare complication after gastrectomy with Billroth II or Roux-en-Y reconstruction, caused by an obstruction in the proximal loop. The biliary stasis and bacterial overgrowth secondary to this obstruction can lead to repeated episodes of acute cholangitis. We present the case of a male patient who had previously undergone gastrectomy with Roux-en-Y reconstruction and later experienced multiple episodes of acute cholangitis secondary to choledocolithiasis. Read More

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January 2020

[Vitamin K deficiency caused by nutritional malabsorption accompanying afferent loop obstruction:a case report].

Nihon Shokakibyo Gakkai Zasshi 2019 ;116(12):1022-1029

Digestive disease Center, Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital.

This case involves a 73-year-old man who visited a clinic because he was experiencing dyspnea on exertion and acid reflux. He was diagnosed with anemia and referred for a medical check-up and treatment by his primary care physician. Iron deficiency anemia and prolonged prothrombin time were confirmed with a blood test and an abdominal enhanced CT revealed marked expansion of the afferent loop after a gastrectomy. Read More

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December 2019

Endoscopic electrohydraulic lithotripsy of an enterolith causing afferent loop syndrome after Whipple's operation.

Endoscopy 2020 05 2;52(5):E176-E177. Epub 2019 Dec 2.

Division of gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.

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EUS-guided enteroenterostomy for nonoperative management of afferent loop syndrome after Whipple resection.

VideoGIE 2019 Oct 13;4(10):461-463. Epub 2019 Aug 13.

Department of Gastroenterology and Hepatology, Liverpool Hospital and University of New South Wales, Sydney, Australia.

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October 2019

Pouch wall thickness and floppy pouch complex.

Surg Endosc 2020 10 24;34(10):4298-4304. Epub 2019 Oct 24.

Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA.

Background: Floppy pouch complex (FPC) consists of disease phenotypes in patients with ileal pouches, including pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and pouch folding. Our recent study demonstrated that lower body weight, lower peripouch fat, family history of inflammatory bowel disease (IBD), female gender, and dyschezia are risk factors for FPC patients with IBD. The aims of this study were to assess the relationship between pouch wall thickness and FPC, and to investigate the association between inflamed and non-inflamed pouch wall thickness. Read More

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October 2020

Afferent Loop Syndrome Due to Volvulus of the Afferent Limb.

ACG Case Rep J 2019 Jul 18;6(7):e00123. Epub 2019 Jul 18.

Department of Gastroenterology, Montefiore Medical Center, Bronx, NY.

A 78-year-old woman with a history of stage IIB gastric adenocarcinoma with previous Billroth II subtotal gastrectomy was admitted with pancreatitis, with subsequent development of fevers and acute jaundice. Transabdominal ultrasound demonstrated bile duct obstruction. An endoscopic retrograde cholangiopancreatography was attempted, but the lumen of the afferent limb appeared distorted without an obstructing lesion. Read More

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Treatment of afferent loop syndrome using digital cholangioscopy through the percutaneous transhepatic biliary drainage route.

Endoscopy 2020 02 17;52(2):E71-E72. Epub 2019 Sep 17.

Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

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February 2020

Endoscopic nasogastric tube insertion for treatment of benign afferent loop obstruction after radical gastrectomy for gastric cancer: A 16-year retrospective single-center study.

Medicine (Baltimore) 2019 Jul;98(28):e16475

Department of Digestion.

Afferent loop obstruction is an uncommon complication associated with Billroth-II distal gastrectomy. Inappropriate treatment may result in life-threatening events as perforation and peritonitis. For the benign afferent loop obstruction, Braun or Roux-en-Y reconstruction has been reported as the choice. Read More

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Afferent loop syndrome of 10 years' onset after gastrectomy.

Asian J Surg 2019 10 10;42(10):935-937. Epub 2019 Jul 10.

Emergency and Critical Care Center, Kurashiki Central Hospital, Japan.

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October 2019

Retrospective cohort study of 925 OAGB procedures. The UK MGB/OAGB collaborative group.

Int J Surg 2019 Sep 9;69:13-18. Epub 2019 Jul 9.

King's College Hospitals, London, United Kingdom; Chelsfield Park Hospital, United Kingdom.

Background: Mini-One Anastomosis Gastric Bypass is a new operation that provides comparable outcomes to the common bariatric procedures. Revisional surgery is still needed after a number of MGB-OAGB procedures. The aim of this study is to report the causes and management of these revisions. Read More

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September 2019

Comparative analysis of afferent loop obstruction between laparoscopic and open approach in pancreaticoduodenectomy.

J Hepatobiliary Pancreat Sci 2019 Oct 1;26(10):459-466. Epub 2019 Aug 1.

Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.

Background: Afferent loop obstruction (ALO) is a rare mechanical complication of pancreaticoduodenectomy (PD) and is associated with a high rate of morbidity and mortality.

Methods: Data from patients who underwent PD between May 2007 and July 2017 at a single large-volume center were retrospectively reviewed.

Results: Of the 3,223 patients who underwent PD, 67 developed ALO. Read More

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October 2019

Endoscopic ultrasound-guided management of malignant afferent loop syndrome after gastric bypass: from diagnosis to therapy.

Endoscopy 2020 03 1;52(3):E84-E85. Epub 2019 Jul 1.

Department of Hepatogastroenterology, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille Université, Hôpital Nord, Marseille, France.

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Endoscopic ultrasound-guided gastrojejunostomy using fully covered metal stent combined with large-loop double-pigtail stent for malignant afferent loop syndrome.

Endoscopy 2019 10 23;51(10):E303-E304. Epub 2019 May 23.

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

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October 2019

Endoscopic ultrasound-guided gastrojejunostomy using a 2-cm lumen-apposing metal stent to treat benign afferent loop syndrome.

Endoscopy 2019 07 12;51(7):695-696. Epub 2019 Apr 12.

Gastroenterology/Internal Medicine, SHARP Grossmont Hospital, San Diego, California, United States.

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Characterization of risk factors for floppy pouch complex in ulcerative colitis.

Int J Colorectal Dis 2019 Jun 11;34(6):1061-1067. Epub 2019 Apr 11.

Center for Inflammatory Bowel Disease, Digestive Disease and Surgery Institute-A31, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH, 44195, USA.

Background: Restorative proctocolectomy with ileal pouch-anal anastomosis can be associated with a variety of complications, including floppy pouch complex (FPC). FPC is defined as the presence of pouch prolapse, afferent limb syndrome, enterocele, redundant loop, and folding pouch on pouchoscopy or contrasted pouchogram. The main symptoms of patients with FPC are dyschezia, incomplete evacuation, and bloating. Read More

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[Two Cases of Afferent Loop Obstruction Treated with Percutaneous Bowel Drainage(PBD)].

Gan To Kagaku Ryoho 2019 Feb;46(2):389-391

Dept. of Surgery, Kurume University School of Medicine.

Here, we report our experiences with 2 cases of afferent loop obstruction with percutaneous bowel drainage(PBD)and present a review of the literature. Case 1 involved a 60-year-old woman. She underwent pancreaticoduodenectomy for pancreatic cancer. Read More

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February 2019