Fujii M, Ishiyama S, Saito H, Ito M, Fujiwara A, Niguma T, Yoshioka M, Shiode J. Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction. World J Gastrointest Endosc 2015; 7(6): 665-669 [PMID: 26078835 DOI: 10.4253/wjge.v7.i6.665]
Corresponding Author of This Article
Masakuni Fujii, MD, Department of Internal Medicine, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Okayama 700-8511, Japan. sktng334@yahoo.co.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Fujii M, Ishiyama S, Saito H, Ito M, Fujiwara A, Niguma T, Yoshioka M, Shiode J. Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction. World J Gastrointest Endosc 2015; 7(6): 665-669 [PMID: 26078835 DOI: 10.4253/wjge.v7.i6.665]
Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan
Takefumi Niguma, Department of Surgery, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan
Author contributions: Fujii M, Ishiyama S, Saito H, Ito M, Fujiwara A, Niguma T, Yoshioka M and Shiode J were responsible for the care of the patients; Fujii M, Ishiyama S and Saito H performed endoscopic therapy; Niguma T conducted patient follow-ups; Fujii M, Yoshioka M and Shiode J wrote the manuscript; all authors read and approved the final manuscript.
Ethics approval: Case reports do not require examination by the Okayama Saiseikai General Hospital Institutional Review Board. Ethical considerations were upheld and patient personal information was protected.
Informed consent: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest: The authors declare that there are no competing financial or personal relationships with other people or organizations that could inappropriately influence the research.
Correspondence to: Masakuni Fujii, MD, Department of Internal Medicine, Okayama Saiseikai General Hospital, 1-17-18 Ifuku-cho, Okayama 700-8511, Japan. sktng334@yahoo.co.jp
Telephone: +81-86-2237151 Fax: +81-86-2357636
Received: October 8, 2014 Peer-review started: October 8, 2014 First decision: November 14, 2014 Revised: December 19, 2014 Accepted: March 16, 2015 Article in press: March 18, 2015 Published online: June 10, 2015 Processing time: 254 Days and 16.6 Hours
Abstract
Progress in double-balloon endoscopy (DBE) has allowed for the diagnosis and treatment of disease in the postoperative bowel. For example, a short DBE, which has a 2.8 mm working channel and 152 cm working length, is useful for endoscopic retrograde cholangiopancreatography in bowel disease patients. However, afferent loop and Roux-limb obstruction, though rare, is caused by postoperative recurrence of biliary tract cancer with intractable complications. Most of the clinical findings involving these complications are relatively nonspecific and include abdominal pain, nausea, vomiting, fever, and obstructive jaundice. Treatments by surgery, percutaneous transhepatic biliary drainage, percutaneous enteral stent insertion, and endoscopic therapy have been reported. The general conditions of patients with these complications are poor due to cancer progression; therefore, a less invasive treatment is better. We report on the usefulness of metallic stent insertion using an overtube for afferent loop and Roux-limb obstruction caused by postoperative recurrence of biliary tract cancer under short DBE in two patients with complexly reconstructed intestines.
Core tip: Malignant afferent loop and Roux-limb obstruction are intractable complications caused by postoperative recurrence of biliary tract cancer. Metallic stent insertion using an overtube under double-balloon endoscopy is a safe and feasible treatment option in such cases.
