Nobuhito Ikeuchi, MD, Department of Gastroenterology and Hepatology at Tokyo Medical University in Tokyo, Japan presents this video case “One-step EUS-guided gastrojejunostomy with use of lumen-apposing metal stent for afferent loop syndrome treatment.”
Afferent loop syndrome is an adverse event of several types of gastric surgery and often causes patient suffering. However, retrograde endoscopic decompression of the afferent loop is not always possible. This video shows a novel technique of a one-step EUS-guided gastrojejunostomy using lumen-apposing metal stent (LAMS) for treatment of afferent loop syndrome.
A 74-year-old woman who underwent pancreaticoduodenostomy 1 year previously for distal cholangiocarcinoma presented with fever and abdominal pain. Computed tomography (CT) showed dilation of the intrahepatic bile duct, pancreatic duct, and afferent loop caused by cancer recurrence. One step EUS-guided gastrojejunostomy was performed using an 8-mm-diameter LAMS which combines a cautery-enabled access catheter (HOT AXIOS; Xlumena Inc., CA, USA). A delivery system including the LAMS was transgastrically and directly advanced into the enlarged afferent loop under EUS guidance in the AutoCut electrosurgical mode without needle puncture. There was no adverse event associated with the procedure. And the symptoms rapidly disappeared. CT the following day showed improvement of the dilation of the intrahepatic bile duct, pancreatic duct, and afferent loop. One-step EUS-guided gastrojejunostomy with a LAMS may be safe and effective method of the treatment for the afferent loop syndrome.
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