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Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy

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Abstract

Afferent loop obstruction caused by cancer recurrence after pancreaticoduodenectomy (PD) can be managed by either surgical or nonsurgical treatment. The general condition of patients with recurrent pancreaticobiliary cancer is often not good enough for them to undergo surgery, so less invasive nonsurgical treatment is desirable. We report a case of a 66-year-old male who had undergone PD for pancreatic head adenocarcinoma 10 months previously and who presented at our hospital with fever and jaundice due to afferent loop obstruction caused by pancreatic cancer recurrence. An endoscopic self-expandable metal stent (SEMS) was placed for afferent loop obstruction without any complications. He quickly recovered after SEMS placement. He retained a good quality of life by receiving chemotherapy until his death due to cancer progression. Our case indicates that this method could be an easy, effective, safe, and less invasive treatment, which may confer a better quality of life for patients with afferent loop obstruction due to cancer recurrence after PD.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics. CA Cancer J Clin. 2013;63:11–30.

    Article  PubMed  Google Scholar 

  2. Matsuno S, Egawa S, Fukuyama S, et al. Pancreatic cancer registry in Japan: 20 years of experience. Pancreas. 2004;28:219–30.

    Article  PubMed  Google Scholar 

  3. Hirata K, Egawa S, Kimura Y, et al. Current status of surgery for pancreatic cancer. Dig Surg. 2007;24:137–47.

    Article  PubMed  Google Scholar 

  4. Ueno H, Kosuge T, Matsuyama Y, et al. A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer. 2009;101:908–15.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Chevallier P, Novellas S, Motamedi JP, et al. Percutaneous jejunostomy and stent placement for treatment of malignant Roux-en-Y obstruction: a case report. Clin Imaging. 2006;30:283–6.

    Article  PubMed  Google Scholar 

  6. Aimoto T, Uchida E, Nakamura Y, et al. Malignant afferent loop obstruction following pancreatoduodenectomy: report of two cases. J Nippon Med Sch. 2006;73:226–30.

    Article  PubMed  Google Scholar 

  7. Pannala R, Brandabur JJ, Gan S, et al. Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience. Gastrointest Endosc. 2011;74:295–302.

    Article  PubMed  Google Scholar 

  8. Beger HG, Treitschke F, Gansauge F, et al. Tumor of the ampulla of Vater: experience with local or radical resection in 171 consecutively treated patients. Arch Surg. 1999;134:526–32.

    Article  CAS  PubMed  Google Scholar 

  9. Morita S, Takemura T, Matsumoto S, et al. Septic shock after percutaneous transhepatic drainage of obstructive afferent loop: case report. Cardiovasc Intervent Radiol. 1989;12:66–8.

    Article  CAS  PubMed  Google Scholar 

  10. Yao NS, Wu CW, Tiu CM. Percutaneous transhepatic duodenal drainage as an alternative approach in afferent loop obstruction with secondary obstructive jaundice in recurrent gastric cancer. Cardiovasc Intervent Radiol. 1998;21:350–3.

    Article  CAS  PubMed  Google Scholar 

  11. Caldicott DG, Ziprin P, Morgan R. Transhepatic insertion of a metallic stent for the relief of malignant afferent loop obstruction. Cardiovasc Intervent Radiol. 2000;23:138–51.

    Article  CAS  PubMed  Google Scholar 

  12. Hosokawa I, Kato A, Shimizu H, et al. Percutaneous transhepatic metallic stent insertion for malignant afferent loop obstruction following pancreaticoduodenectomy: a case report. J Med Case Rep. 2012;6:198.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Espinel J, Sanz O, Vivas S, et al. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc. 2006;20:1083–7.

    Article  CAS  PubMed  Google Scholar 

  14. Burdick JS, Garza AA, Magee DJ, et al. Endoscopic management of afferent loop syndrome of malignant etiology. Gastrointest Endosc. 2002;55:602–5.

    Article  PubMed  Google Scholar 

  15. Sasaki T, Isayama H, Kogure H, et al. Double-balloon enteroscope-assisted enteral stent placement for malignant afferent-loop obstruction after Roux-en-Y reconstruction. Endoscopy. 2014;46:E541–2.

    Article  PubMed  Google Scholar 

  16. Lee H, Park JC, Shin SK, et al. Preliminary study of enteroscopy-guided, self-expandable metal stent placement for malignant small bowel obstruction. J Gastroenterol Hepatol. 2012;27:1181–6.

    Article  PubMed  Google Scholar 

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Disclosures

Conflict of Interest:

Arata Sakai, Hideyuki Shiomi, Yousuke Yagi, Takashi Kobayashi, Yuuki Shiomi, Mamoru Takenaka, Namiko Hoshi, Yoshifumi Arisaka, Yoshihiro Okabe, Hiromu Kutsumi and Takeshi Azuma declare that they have no conflict of interest.

Human Animal Rights:

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimental (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Concent:

Informed consent was obtained from all patients for being included in the study.

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Authors and Affiliations

  1. Department of Gastroenterology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan

    Arata Sakai, Hideyuki Shiomi, Yoshihiro Okabe, Yousuke Yagi, Takashi Kobayashi, Yuuki Shiomi, Mamoru Takenaka, Namiko Hoshi, Yoshifumi Arisaka, Hiromu Kutsumi & Takeshi Azuma

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  1. Arata Sakai
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  2. Hideyuki Shiomi
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  3. Yoshihiro Okabe
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  4. Yousuke Yagi
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  5. Takashi Kobayashi
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  6. Yuuki Shiomi
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  7. Mamoru Takenaka
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  8. Namiko Hoshi
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  9. Yoshifumi Arisaka
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  10. Hiromu Kutsumi
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  11. Takeshi Azuma
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Correspondence to Arata Sakai.

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Sakai, A., Shiomi, H., Okabe, Y. et al. Effectiveness of endoscopic self-expandable metal stent placement for afferent loop obstruction caused by pancreatic cancer recurrence after pancreaticoduodenectomy. Clin J Gastroenterol 8, 103–107 (2015). https://doi.org/10.1007/s12328-015-0556-0

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  • DOI: https://doi.org/10.1007/s12328-015-0556-0

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