Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jul 15;13(7):684-692.
doi: 10.4251/wjgo.v13.i7.684.

Clinical management for malignant afferent loop obstruction

Arata Sakai  1 , Hideyuki Shiomi  2 , Atsuhiro Masuda  2 , Takashi Kobayashi  2 , Yasutaka Yamada  2 , Yuzo Kodama  2
Affiliations
Review

Clinical management for malignant afferent loop obstruction

Arata Sakai et al. World J Gastrointest Oncol. .

Abstract

Afferent loop obstruction (ALO) is defined as duodenal or jejunal mechanical obstruction at the proximal anastomosis site of a gastrojejunostomy. With advances in chemotherapy, the incidence of malignant ALO is increasing. Malignant ALO can be complicated by ischemia, gangrenous bowel, pancreatitis, and ascending cholangitis. Moreover, the general condition of patients with recurrent cancer is often poor. Therefore, accurate and rapid diagnosis and minimally invasive treatments are required. However, no review articles on the diagnosis and treatment of malignant ALO have been published. Through literature searching, we reviewed related articles published between 1959 and 2020 in the PubMed database. Herein, we present recent advances in the diagnosis and treatment of malignant ALO and describe future perspectives. Endoscopic transluminal self-expandable metal stent (SEMS) placement is considered the standard treatment for malignant ALO, as this procedure is well established and less invasive. However, with the development of interventional endoscopic ultrasound (EUS) in recent years, the usefulness of EUS-guided gastrojejunostomy has been reported. Moreover, through indirect comparison, this approach has been reported to be superior to transluminal SEMS placement. It is expected that a safer and less invasive treatment method will be established through the continued advancement and innovation of interventional endoscopy techniques.

Keywords: Endoscopic self-expandable metal stent placement; Endoscopic ultrasound guided gastrojejunostomy; Lumen-apposing metal stent; Malignant afferent loop obstruction.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A computed tomography scan. A: Distention of the afferent loop by a recurrent tumor; B: Biliary dilation; C: Coronal section.
Figure 2
Figure 2
Therapeutic schemas for malignant afferent loop obstruction. A: Treatment of malignant afferent loop obstruction (ALO) with obstructive jaundice by percutaneous transhepatic biliary drainage; B: Treatment of malignant ALO by direct percutaneous afferent loop drainage; C: Treatment of malignant ALO by endoscopic transluminal self-expandable metal stent; D: Treatment of malignant ALO by endoscopic ultrasound-guided gastrojejunostomy.
Figure 3
Figure 3
Endoscopic transluminal self-expandable metal stent for malignant afferent loop obstruction. A: Neoplastic stenosis in the afferent loop blocked further passage of the endoscope; B: The stenosis was confirmed with contrast media; C: Self-expandable metal stent was placed by the standard through-the-scope technique under fluoroscopic view; D: Endoscopic view.
Figure 4
Figure 4
Endoscopic ultrasound-guided gastrojejunostomy for malignant afferent loop obstruction. A: Endoscopic ultrasound (EUS) shows the dilated afferent loop; B: Dilated afferent loop was punctured using a 19G FNA needle with an EUS guide; C: Self-expandable metal stent was placed using the standard through-the-scope technique under fluoroscopic view; D: Endoscopic view.
See this image and copyright information in PMC

References

    1. Blouhos K, Boulas KA, Tsalis K, Hatzigeorgiadis A. Management of afferent loop obstruction: Reoperation or endoscopic and percutaneous interventions? World J Gastrointest Surg . 2015;7:190–195. - PMC - PubMed
    1. Song KB, Yoo D, Hwang DW, Lee JH, Kwon J, Hong S, Lee JW, Youn WY, Hwang K, Kim SC. Comparative analysis of afferent loop obstruction between laparoscopic and open approach in pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci . 2019;26:459–466. - PubMed
    1. Termsinsuk P, Chantarojanasiri T, Pausawasdi N. Diagnosis and treatment of the afferent loop syndrome. Clin J Gastroenterol . 2020;13:660–668. - PubMed
    1. Aimoto T, Uchida E, Nakamura Y, Katsuno A, Chou K, Tajiri T, Naito Z. Malignant afferent loop obstruction following pancreaticoduodenectomy: report of two cases. J Nippon Med Sch . 2006;73:226–230. - PubMed
    1. Sakai A, Shiomi H, Okabe Y, Yagi Y, Kobayashi T, Shiomi Y, Takenaka M, Hoshi N, Arisaka Y, Kutsumi H, Azuma T. Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy. Clin J Gastroenterol . 2015;8:103–107. - PubMed