Post written by Kamal M. Hassan, MD, from Weill Cornell Medicine, New York, New York, USA.

In this case, a 78-year-old patient with a history of numerous abdominal surgeries complicated by adhesions and small-bowel obstructions underwent an eventual surgical gastrojejunostomy. The patient developed progressive peroral intolerance, and imaging revealed an acquired afferent loop syndrome as a rare postoperative adverse event. The patient’s extensive surgical background made traditional interventions problematic.

Therefore, a novel EUS-guided Braun-type anastomosis was employed. Using a lumen-apposing metal stent, we successfully established an endoscopic connection between the afferent and efferent limbs. This innovative technique alleviated the patient’s distressing symptoms, demonstrating a potential procedural-based alternative for managing such obstructions, especially in complex surgical cases.

The video focuses on the endoscopic management of a distinctive postsurgical anatomy. Although the EUS bypass for afferent limb syndrome has been explored, its application for a benign indication remains relatively novel. Showcasing this video provides valuable insight and broadens the understanding of the procedure’s versatility and potential applications.

From our experience, other endoscopists can discern the necessary procedural steps and details as well as recognize that performing an efferent-to-afferent jejunojejunostomy is entirely safe and feasible. Furthermore, there is an established long-term management strategy for yearly stent exchanges that has been feasible without issue. The pivotal takeaway is that, when executed correctly, it can result in a notably favorable clinical outcome.

A and B, Abdominal CT scan showing a surgical gastrojejunostomy pull-up with a severely dilated afferent limb (red arrow).

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