ENDOSCOPIC THERAPY OF AN AFFERENT LOOP SYNDROM WITH CHOLANGITIS IN A PATIENT WITH PANCREATIC CANCER

Aims The afferent loop syndrom is a rare complication after roux-en-y gastric bypass (RYGB). Although surgical therapy is the standard, many patients are not suitable for surgery due to poor medical conditions. In those patients interventional endoscopy should be considered. We report the case of an endoscopic gastrojejunostomy in a patient with afferent loop syndrom and cholangitis.

Methods The 84-year old male patient was diagonsed with pancreatic cancer in 04/2018. Unfortunately the surgical exploration found peritonealcarcinosis and hepatic metastases. Thus a RYGB with a biliodigestive anastomosis was created. The patient refused palliatve chemotherapy and presented in 10/2019 with jaundice and cholangitis.

Results Computertomography showed a widely dilated afferent loop with consecutive biliary dilation. We discussed all therapeutic options with the patient and decided to perform a endoscopic gastrojejunostomy of the afferent loop. After transgastric endosonographic visualization of the dilated afferent loop a lumen apposing metal stent (LAMS) was placed. In the following days the patients condition improved and he was discharged three days later. Four weeks after endoscopic gastrojejunostomy endoscopy through the LAMS was performed and showed a regular biliodigestive anastomosis without stenosis.

Conclusions The endoscopic gastrojejunostomy with LAMS is a new helpful procedure especially for patients in poor medical condition, which can prevent invasive surgery and help to improve prognosis and quality of life