535 results match your criteria Afferent Loop Syndrome


Endoscopic Ultrasound-guided Gastrointestinal Anastomosis: Current status and Future perspectives>.

Dig Endosc 2022 Jun 20. Epub 2022 Jun 20.

Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.

Background: Both clinical experience and supporting data have improved drastically in the context of EUS-gastrointestinal anastomosis (EUS-GIA). Where outcomes used to be questioned, focus has now moved towards performing comparative studies, optimizing technical approaches, improving patient selection and developing well-defined treatment algorithms.

Methods: The purpose of this review is to provide an overview of technical developments within EUS-GIA, discuss the current status of EUS-GIA and future directions. Read More

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Afferent-Loop Syndrome Treated with Endoscopic Ultrasound-Guided Drainage of the Afferent Loop with a Plastic Stent.

Case Rep Gastroenterol 2022 Jan-Apr;16(1):122-128. Epub 2022 Mar 25.

Department of General Internal Medicine 2, Kawasaki Medical School, Okayama, Japan.

Afferent-loop syndrome (ALS) is known as a rare complication of partial or total gastrectomy and also occurs after pancreatoduodenectomy. The symptoms of ALS vary with the location of the mechanical obstruction, and the choice of therapeutic method should reflect the patient's condition and disease state. Herein, we report the use of endoscopic ultrasound (EUS)-guided afferent loop drainage with a plastic stent and its reintervention for malignant ALS. Read More

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Severe acute pancreatitis in the early postoperative period due to afferent loop syndrome following gastrectomy for gastric cancer.

Ann R Coll Surg Engl 2022 Apr 21. Epub 2022 Apr 21.

All India Institute of Medical Sciences, Rishikesh India.

Afferent loop syndrome (ALS) is an uncommon complication of gastrojejunostomy. It may be acute or chronic depending on whether symptoms manifest within 7 days of surgery. Rarely acute ALS may give rise to acute pancreatitis. Read More

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Endoscopic ultrasound-guided treatment for malignant afferent loop obstruction after Roux-en-Y reconstruction.

DEN open 2021 Apr 10;1(1):e3. Epub 2021 Feb 10.

Department of Gastroenterology Kyoto Second Red Cross Hospital Kyoto Japan.

The usefulness of endoscopic ultrasound (EUS)-guided gastrojejunostomy (EUS-GJ) using a lumen-apposing metal stent (LAMS) has been reported. However, LAMS is not available in many countries and is more expensive than a conventional fully covered self-expandable metal stent (FCSEMS). We treated cases of malignant afferent loop obstruction after Roux-en-Y reconstruction: three patients underwent EUS-guided hepaticoenterostomy (EUS-HES) and one patient underwent EUS-GJ with a conventional biliary FCSEMS, instead of EUS-GJ with a LAMS. Read More

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An Unusual Presentation of Obstructive Jaundice Due to Dilated Proximal Small Bowel Loops After Gastrojejunostomy: Afferent Loop Syndrome.

Cureus 2022 Jan 14;14(1):e21258. Epub 2022 Jan 14.

Radiology, Aga Khan University Hospital, Karachi, PAK.

Afferent loop syndrome is reported to be one of the very rare complications after gastrojejunostomy. The usual presentation in patients is with abdominal pain, distension and vomiting. It may present acutely because of complete obstruction, usually occurs early after surgery and is lethal in its course unless treated promptly with surgical management. Read More

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January 2022

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.

Endoscopy 2022 02 22;54(2):185-205. Epub 2021 Dec 22.

Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.

1: ESGE recommends the use of endoscopic ultrasound-guided biliary drainage (EUS-BD) over percutaneous transhepatic biliary drainage (PTBD) after failed endoscopic retrograde cholangiopancreatography (ERCP) in malignant distal biliary obstruction when local expertise is available.Strong recommendation, moderate quality evidence. 2: ESGE suggests EUS-BD with hepaticogastrostomy only for malignant inoperable hilar biliary obstruction with a dilated left hepatic duct when inadequately drained by ERCP and/or PTBD in high volume expert centers. Read More

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February 2022

Raynaud's phenomenon in a drummer player: Microvascular disorder and nailfold video capillaroscopic findings.

EXCLI J 2021 28;20:1526-1531. Epub 2021 Oct 28.

Department of Life, Health and Environmental Sciences, University of L'Aquila, 67100 L'Aquila, Italy.

Drummers are usually exposed to intensive physical stress and occupational diseases that have been only partially investigated. The majority of studies focus on musculoskeletal problems while microvascular abnormalities have been less considered. We report on a case of a 19-year-old drummer affected by Raynaud's phenomenon. Read More

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October 2021

Endoscopic ultrasound-guided entero-enterostomy with a hybrid biflanged metal stent for relief of afferent loop syndrome.

Dig Endosc 2022 Jan 23;34(1):e17-e19. Epub 2021 Nov 23.

Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

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January 2022

Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome.

Clin Endosc 2021 Nov 15;54(6):810-817. Epub 2021 Nov 15.

Division of Gastroenterology and Hepatobiliary and Pancreatic Diseases, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.

Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Read More

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November 2021

Successful treatment of remnant gastric cancer with afferent loop syndrome managed by percutaneous transhepatic cholangial drainage followed by elective gastrectomy: a case report.

Surg Case Rep 2021 Sep 28;7(1):219. Epub 2021 Sep 28.

Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan.

Background: There are only few reported cases of remnant gastric cancer with concomitant afferent loop syndrome. Emergency surgery is the standard treatment strategy for this disease. However, some afferent loop syndrome cases, especially those with complete obstruction, can lead to a septic state, which makes performing emergency surgery risky. Read More

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September 2021

Surgical bypass in malignant afferent loop syndrome.

BMJ Case Rep 2021 Aug 13;14(8). Epub 2021 Aug 13.

General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.

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Percutaneous Transhepatic Bowel Stent Deployment: An Alternative Approach for Malignant Afferent Loop Obstruction Following Whipple's Procedure.

Cureus 2021 Jun 27;13(6):e15964. Epub 2021 Jun 27.

Interventional Radiology, Shifa International Hospital, Islamabad, PAK.

Afferent loop syndrome is an uncommon postoperative complication. Currently, we lack a therapeutic option for treatment of malignant afferent loop obstruction following procedures like Whipple's. Here we present a case of afferent loop obstruction in a known case of pancreatic carcinoma, status after Whipple's procedure, in which we used a percutaneous transhepatic approach to relieve the afferent loop obstruction using a self-expanding bare metal stent. Read More

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Perforated Blind Pouch: An Unusual Late Complication Following Lateral Anastomosis After a Right Hemicolectomy.

Cureus 2021 May 15;13(5):e15044. Epub 2021 May 15.

Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND.

Blind loop syndrome (BLS) is a well-recognized delayed complication in small bowel strictures, stenosis, fistulas, diverticula, or post-gastrectomy afferent loop syndrome. However, due to its delayed presentation, BLS after side-to-side bowel anastomosis is inadequately reported. The vicious cycle of the blind loop is due to bacterial overgrowth, resulting in diarrhea, weight loss, malnutrition, and rarely mucosal erosion, bleeding, and perforation peritonitis. Read More

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

Surg Endosc 2022 04 28;36(4):2393-2400. 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