Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction.

Area of Science:

• Gastroenterology
• Oncology
• Endoscopic Surgery

Background:

• Double-balloon endoscopy (DBE) advances diagnosis and treatment in postoperative bowel disease.
• Short DBE is valuable for endoscopic retrograde cholangiopancreatography in specific patient groups.
• Afferent loop and Roux-limb obstruction, though rare, can arise from biliary tract cancer recurrence.

Observation:

• Clinical findings for these obstructions are often nonspecific, including abdominal pain, nausea, vomiting, fever, and jaundice.
• Previous treatments include surgery, percutaneous biliary drainage, enteral stenting, and endoscopic therapy.
• Patients often have poor general condition due to advanced cancer, necessitating less invasive options.

Findings:

• Metallic stent insertion via an overtube using short DBE was successfully applied in two patients.
• This technique addressed afferent loop and Roux-limb obstruction caused by recurrent biliary tract cancer.
• The intervention was performed in patients with complex intestinal reconstructions.

Implications:

• This study highlights the utility of metallic stent insertion with short DBE as a less invasive treatment for complex obstructions.
• It offers a potential therapeutic strategy for patients with recurrent biliary tract cancer and surgically altered anatomy.
• Further research may explore the broader application and long-term outcomes of this endoscopic approach.