Endoscopy 2018; 50(09): 891-895
DOI: 10.1055/s-0044-102254
Innovations and brief communications
© Georg Thieme Verlag KG Stuttgart · New York

Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience

Olaya I. Brewer Gutierrez
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Shayan S. Irani
2  Division of Gastroenterology and Hepatology, Virginia Mason, Seattle, Washington, United States
,
Saowanee Ngamruengphong
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Hanaa D. Aridi
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Rastislav Kunda
3  Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
,
Ali Siddiqui
4  Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
,
Markus Dollhopf
5  Division of Gastroenterology and Hepatology, Leitender Oberarzt der Klinik, Munchen, Germany
,
Jose Nieto
6  Division of Gastroenterology and Hepatology, Borland Groover Clinic, Jacksonville, Florida, United States
,
Yen-I Chen
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Nadav Sahar
2  Division of Gastroenterology and Hepatology, Virginia Mason, Seattle, Washington, United States
,
Majidah A. Bukhari
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Omid Sanaei
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Marcia I. Canto
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Vikesh K. Singh
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
,
Richard Kozarek
2  Division of Gastroenterology and Hepatology, Virginia Mason, Seattle, Washington, United States
,
Mouen A. Khashab
1  Division of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, Maryland, United States
› Author Affiliations
Further Information

Publication History

submitted 20 July 2017

accepted after revision 12 January 2018

Publication Date:
02 March 2018 (eFirst)

Abstract

Background Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE.

Methods This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected.

Results 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P < 0.001).

Conclusion EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.