EUS-guided hepaticogastrostomy for patients with afferent loop syndrome: a comparison with EUS-guided gastroenterostomy or percutaneous drainage.
Afferent loop syndrome
Endoscopic ultrasound
Gastroenterostomy
Hepaticogastrostomy
PTC
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
04 2022
04 2022
Historique:
received:
21
12
2020
accepted:
17
04
2021
pubmed:
29
4
2021
medline:
21
4
2022
entrez:
28
4
2021
Statut:
ppublish
Résumé
Where palliative surgery or percutaneous drainage used to be the only option in patients with afferent loop syndrome, endoscopic management by EUS-guided gastroenterostomy has been gaining ground. However, EUS-guided hepaticogastrostomy might also provide sufficient biliary drainage. Our aim was to evaluate the feasibility of EUS-guided hepaticogastrostomy for the management of afferent loop syndrome and provide comparative data on the different approaches. The institutional databases were queried for all consecutive minimally invasive procedures for afferent loop syndrome. A retrospective, dual-centre analysis was performed, separately analysing EUS-guided hepaticogastrostomy, EUS-guided gastroenterostomy and percutaneous drainage. Efficacy, safety, need for re-intervention, hospital stay and overall survival were compared. In total, 17 patients were included (mean age 59 years (± SD 10.5), 23.5% female). Six patients, which were ineligible for EUS-guided gastroenterostomy, were treated with EUS-guided hepaticogastrostomy. EUS-guided gastroenterostomy and percutaneous drainage were performed in 6 and 5 patients respectively. Clinical success was achieved in all EUS-treated patients, versus 80% in the percutaneous drainage group (p = 0.455). Furthermore, higher rates of bilirubin decrease were seen among patients undergoing EUS: > 25% bilirubin decrease in 10 vs. 1 patient(s) in the percutaneously drained group (p = 0.028), with > 50% and > 75% decrease identified only in the EUS group. Using the ASGE lexicon for adverse event grading, adverse events occurred only in patients treated with percutaneous drainage (60%, p = 0.015). And last, the median number of re-interventions was significantly lower in patients undergoing EUS (0 (IQR 0.0-1.0) vs. 1 (0.5-2.5), p = 0.045) when compared to percutaneous drainage. In the management of afferent loop syndrome, EUS seems to outperform percutaneous drainage. Moreover, in our cohort, EUS-guided gastroenterostomy and hepaticogastrostomy provided similar outcomes, suggesting EUS-guided hepaticogastrostomy as the salvage procedure in situations where EUS-guided gastroenterostomy is not feasible or has failed.
Identifiants
pubmed: 33909126
doi: 10.1007/s00464-021-08520-z
pii: 10.1007/s00464-021-08520-z
doi:
Substances chimiques
Bilirubin
RFM9X3LJ49
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2393-2400Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Pannala R, Brandabur JJ, Gan SI, Gluck M, Irani S, Patterson DJ, Ross AS, Dorer R, Traverso LW, Picozzi VJ, Kozarek RA (2011) Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience. Gastrointest Endosc 74:295–302
doi: 10.1016/j.gie.2011.04.029
Blouhos K, Andreas K, Tsalis K, Hatzegeorgiadis A (2015) Management of afferent loop syndrome: reoperation or endoscopic and percutaneous interventions? World J Gastrointest Surg 7:190–195
doi: 10.4240/wjgs.v7.i9.190
Katagiri H, Tahara K, Yoshikawa K, Lefor AK, Kubota T, Mizokami K (2016) Afferent loop syndrome after Roux-en-Y total gastrectomy caused by volvulus of the Roux-Limb. Case Rep Surg 2016:4930354
pubmed: 27429828
pmcid: 4939196
Kim HJ, Moon JH, Choi HJ, Koo HC, Park SJ, Cheon YK, Cho YD, Lee MS, Shim CS (2010) Endoscopic removal of an enterolith causing afferent loop syndrome using electrohydraulic lithotripsy. Dig Endosc 22:220–222
doi: 10.1111/j.1443-1661.2010.00981.x
Mullan D, Uberoi R (2016) The obstructed afferent loop: Percutaneous options. Int J Gastrointest Interv 5:129–137
doi: 10.18528/gii160019
Kim KH, Lee HB, Kim SH, Kim MC, Jung GJ (2015) Role of percutaneous transhepatic biliary drainage in patients with complications after gastrectomy. Int Surg 101:78–83
doi: 10.9738/INTSURG-D-15-00117.1
Monino L, Barthet M, Gonzalez JM (2020) Endoscopic ultrasound-guided management of malignant afferent loop syndrome after gastric bypass: from diagnosis to therapy. Endoscopy 52(3):E84–E85
doi: 10.1055/a-0948-5033
Itoi T, Baron TH, Khashab MA, Tsuchiya T, Irani S, Dhir V, Teoh AYB (2017) Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 29:495–502
doi: 10.1111/den.12794
Bamba S, Shiomi H, Fujiyama Y (2013) Afferent loop syndrome successfully treated by endoscopic ultrasound-guided transgastric drainage. Dig Endosc 25:632–623
doi: 10.1111/den.12168
Yamamoto K, Tsuchiya T, Tanaka R, Mitsuyoshi H, Mukai S, Nagakawa Y, Itoi T (2017) Afferent loop syndrome treated by endoscopic ultrasound-guided gastrojejunostomy, using a lumen-apposing metal stent with an electrocautery-enhanced delivery system. Endoscopy 49:E270–E272
doi: 10.1055/s-0043-115893
Shah A, Khanna L, Sethi A (2015) Treatment of afferent limb syndrome: novel approach with endoscopic ultrasoundguided creation of a gastrojejunostomy fistula and placement of lumen-apposing stent. Endoscopy 47(Suppl 1 UCTN):E309–E310
pubmed: 26115389
Brewer Gutierrez OI, Irani SS, Ngamruengphong S, Aridi HD, Kunda R, Siddiqui A, Dollhopf M, Nieto J, Chen YI, Sahar N, Bukhari MA, Sanaei O, Canto MI, Singh VK, Kozarek R, Kashab MA (2018) Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience. Endoscopy 50:891–5
doi: 10.1055/s-0044-102254
Rodrigues-Pinto E, Grimm IS, Baron TH (2016) Efficacy of endoscopically created bypass anastomosis in treatment of afferent limb syndrome: a single-center study. Clin Gastroenterol Hepatol 14:633–637
doi: 10.1016/j.cgh.2015.11.010
Ratone JP, Caillol F, Bories E, Pesenti C, Godat S, Giovannini M (2015) Hepatogastrostomy by EUS for malignant afferent loop obstruction after duodenopancreatectomy. Endosc Ultrasound 4(3):250–252
doi: 10.4103/2303-9027.163017
Bronswijk M, Vanella G, Petrone MC, Arcidiacono PG, van Malenstein H, Laleman W, Van der Merwe S (2020) EUS-guided gastroenterostomy: less is more! The wireless EUS-guided gastroenterostomy simplified technique. Video GIE 5(9):442
doi: 10.1016/j.vgie.2020.06.012
Cotton PB, Eisen GM, Aabakken L, Baron TH, Hutter MM, Jacobson BC, Mergener K, Nemcek A, Petersen BT, Petrini JL, Pike IM, Rabeneck L, Romagnuolo J, Vargo JJ (2010) A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 71:446–454
doi: 10.1016/j.gie.2009.10.027
De Cassan C, Bories E, Pesenti C, Caillol F, Godat S, Ratone JP (2017) Use of partially covered and uncovered metallic prosthesis for endoscopic ultrasound-guided hepaticogastrostomy: Results of a retrospective monocentric study. Endosc Ultrasound 6:329–35
doi: 10.4103/2303-9027.209869
Vanella G, Bronswijk M, Maleux G, van Malenstein H, Laleman W, Van der Merwe S (2020) EUS-guided intrahepatic biliary drainage: a large retrospective series and subgroup comparison between percutaneous drainage in hilar stenoses or postsurgical anatomy. Endosc Int Open 8:E1782–E1794
doi: 10.1055/a-1264-7511