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Robotic Myotomy and Partial Fundoplication for Achalasia
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Clinical management for malignant afferent loop obstruction.

Arata Sakai1, Hideyuki Shiomi2, Atsuhiro Masuda2

  • 1Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan. asakai@med.kobe-u.ac.jp.

World Journal of Gastrointestinal Oncology
|July 29, 2021
PubMed
Summary

Malignant afferent loop obstruction (ALO) is increasingly diagnosed. Endoscopic ultrasound-guided gastrojejunostomy shows promise as a less invasive treatment compared to traditional self-expandable metal stents.

Keywords:
Endoscopic self-expandable metal stent placementEndoscopic ultrasound guided gastrojejunostomyLumen-apposing metal stentMalignant afferent loop obstruction

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Interventional Endoscopy

Background:

  • Afferent loop obstruction (ALO) involves mechanical blockage in the duodenum or jejunum at the gastrojejunostomy site.
  • Malignant ALO incidence is rising due to chemotherapy advancements, posing risks of ischemia, gangrene, pancreatitis, and cholangitis.
  • Patients with recurrent cancer often have poor general health, necessitating rapid diagnosis and minimally invasive treatments.

Purpose of the Study:

  • To review recent advancements in the diagnosis and treatment of malignant afferent loop obstruction.
  • To compare the efficacy of endoscopic transluminal self-expandable metal stent (SEMS) placement with newer endoscopic ultrasound-guided gastrojejunostomy.

Main Methods:

  • A literature search was conducted in the PubMed database for articles published between 1959 and 2020.
  • Review of studies focusing on the diagnosis and management of malignant afferent loop obstruction.
  • Analysis of outcomes comparing self-expandable metal stent (SEMS) placement and endoscopic ultrasound-guided gastrojejunostomy.

Main Results:

  • Endoscopic transluminal self-expandable metal stent (SEMS) placement is the established standard treatment for malignant ALO.
  • Endoscopic ultrasound-guided gastrojejunostomy has emerged as a potentially superior and less invasive alternative.
  • Indirect comparisons suggest endoscopic ultrasound-guided gastrojejunostomy offers better outcomes than transluminal SEMS placement.

Conclusions:

  • Accurate and rapid diagnosis of malignant ALO is crucial given associated complications and patient comorbidities.
  • Endoscopic ultrasound-guided gastrojejunostomy represents a promising, less invasive treatment option for malignant ALO.
  • Continued innovation in interventional endoscopy is expected to yield safer and more effective treatment methods.