Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
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초록
Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomyreconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment formalignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guidedgastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reportsshowed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated thatpatients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention ratethan those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be consideredas a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD orendoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatmentfor ALS.
Abstract
Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomyreconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment formalignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guidedgastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reportsshowed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated thatpatients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention ratethan those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be consideredas a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD orendoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatmentfor ALS.
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