Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction.

Area of Science:

• Gastroenterology
• Interventional Endoscopy
• Surgical Oncology

Background:

• Malignant afferent loop obstruction (ALO) presents a rare and challenging clinical scenario.
• Advancements in endoscopic technology, such as balloon-assisted enteroscopy and 9 Fr self-expandable metal stents (SEMS), have facilitated transluminal treatment options.

Purpose of the Study:

• To evaluate the efficacy and safety of endoscopic transluminal treatment for malignant ALO.
• To assess the long-term outcomes of SEMS placement in patients with malignant ALO.

Main Methods:

• Retrospective evaluation of 22 patients with symptomatic malignant ALO undergoing endoscopic transluminal treatment from July 2016 to March 2022.
• Analysis of outcomes in an initial cohort (n=22) and a specific SEMS cohort (n=18).

Main Results:

• High technical and clinical success rates of 95.5% were achieved in the initial cohort with a median procedural time of 28.0 minutes.
• One early complication (guidewire-induced micro-perforation) occurred in the initial cohort (4.5%); no early complications were noted in the SEMS cohort.
• Recurrent obstruction occurred in 11.1% of the SEMS cohort, managed by additional SEMS placement or conservative treatment.

Conclusions:

• Endoscopic transluminal treatment demonstrates high technical and clinical success with short procedural times for malignant ALO.
• Endoscopic SEMS placement is a safe and effective treatment modality for malignant ALO.
• Additional SEMS placement is a viable option for managing re-obstruction.