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Afferent Loop Syndrome

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Shyam Kumar – One of the best experts on this subject based on the ideXlab platform.

Jeong Hwan Yook – One of the best experts on this subject based on the ideXlab platform.

  • Afferent Loop Syndrome: Treatment by Means of the Placement of Dual Stents
    AJR. American journal of roentgenology, 2012
    Co-Authors: Kichang Han, Ho Young Song, Jin Hyoung Kim, Jung Hoon Park, Deok Ho Nam, Min Hee Ryu, Jeong Hwan Yook
    Abstract:

    OBJECTIVE. The purpose of this article is to assess the technical feasibility and clinical effectiveness of the placement of partially covered self-expandable dual stents in patients with Afferent Loop Syndrome. MATERIALS AND METHODS. Data from 13 consecutive patients who had undergone partially covered dual stent placement for Afferent Loop Syndrome after various types of surgery were retrospectively analyzed. Nine patients underwent stent placement via the percutaneous transhepatic biliary drainage tract, and four patients underwent placement via the peroral route. A total of 16 stents were used in this study (i.e., 15 dual stents and one fully covered esophageal stent). RESULTS. The route of stent insertion was determined on the basis of each patient’s general condition, the site of obstruction, anatomic variations, and associated symptoms. Stent placement was technically successful in all patients. After stent placement, 12 of 13 patients experienced normalization of their abnormal biliary laboratory …

Rivka Zissin – One of the best experts on this subject based on the ideXlab platform.

  • Computed tomographic features of Afferent Loop Syndrome: pictorial essay.
    Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes, 2005
    Co-Authors: Rivka Zissin, Marjorie Hertz, Haim Paran, Alexandra Osadchy, Gabriela Gayer
    Abstract:

    ALS, a rare condition, is often difficult to diagnose clinically but has a characteristic CT appearance as a U-shaped, fluid-filled tubular structure crossing the midline between the abdominal aortaorta and the superior mesenteric artery. Radiologists should be familiar with this rare entity, as awareness of its pathognomonic CT features will aid in establishing the correct diagnosis as well as in offering a tentative etiology as a guide for treatment.

  • CT findings of Afferent Loop Syndrome after a subtotal gastrectomy with Roux-en-Y reconstruction
    Emergency Radiology, 2004
    Co-Authors: Rivka Zissin
    Abstract:

    A rare case of combined Afferent Loop Syndrome following Roux-en Y reconstruction and small bowel obstruction due to adhesions at the enteroenterostomy is presented. The CT findings of the obstruction of both the Afferent and the efferent limbs are demonstrated, with emphasis on the characteristic CT features of Afferent Loop Syndrome.

  • CT diagnosis of Afferent Loop Syndrome
    Clinical radiology, 2002
    Co-Authors: Gabriela Gayer, D Barsuk, Marjorie Hertz, Sara Apter, Rivka Zissin
    Abstract:

    Abstract OBJECTIVE: To report the computed tomography (CT) features of Afferent Loop Syndrome which is often clinically unsuspected. MATERIALS AND METHODS: The CT studies of five patients with Afferent Loop Syndrome were reviewed. These patients had undergone gastroenterostomy and other surgical procedures, for malignant neoplasms in four and for peptic ulcer in one. Patients presented between 4 months and 15 years (average 5.5 years) after surgery. Symptoms were acute in all patients, the most common symptom being abdominal pain. In addition three of the patients had chronic symptoms including recurrent episodes of abdominal pain, recurrent ascending cholangitis, jaundice and bilious vomiting. RESULTS: The obstructed Afferent Loop appeared on CT as a fluid-filled tubular mass with an average diameter of 5.3 cm. Valvulae conniventes were identified in all, and small intraluminal air bubbles in four. The dilated Afferent Loop was opacified with oral contrast material in only one patient. The Loop was located in the subhepatic area in three patients and crossed the midline between the aorta and the superior mesenteric vessels in the other two. Additional findings included biliary dilatation in all five patients and signs of pancreatitis in one. Treatment was surgical in four patients (delayed for four months in one) and conservative in one. CONCLUSION: A fluid-filled tubular structure containing small air bubbles in the right upper quadrant or crossing the midline on CT in symptomatic patients after gastroenterostomy is characteristic of a dilated, possibly obstructed, Afferent Loop. The diagnosis is often not suspected clinically since patients may present many years after the initial surgery. Recognition of the characteristic CT findings will avoid both inappropriate procedures such as aspiration or drainage of an obstructed Afferent Loop and delay in treatment. Gayer, G. etal . (2002). Clinical RadiRadiology 57 , 835–839.

Keon-young Lee – One of the best experts on this subject based on the ideXlab platform.

  • Percutaneous Cholangioscopic Lithotripsy for Afferent Loop Syndrome Caused by Enterolith Development after Roux-en-Y
    , 2016
    Co-Authors: Clin Endosc, Seong Hyun Kim, Seok Jeong, Don Haeng Lee, Sung Soo Yoo, Keon-young Lee
    Abstract:

    Afferent Loop obstruction caused by enterolith formation is rare and cannot be easily treated with endoscopy because of the difficulty as-sociated with the nonsurgical removal of enteroliths. A 74-year-old woman was admitted with fever and acute abdominal pain. Clinical features and imaging studies suggested Afferent Loop obstruction caused by an enterolith after Roux-en-Y hepaticojejunostomy. Percuta-neous transhepatic biliary drainage was initially performed because of severe cholangitis with septic shock. The enterolith was located in the jejunal limb adjacent to the hepaticojejunostomy site. Cholangioscopic lithotripsy was performed through the percutaneous transhe-patic route to the enterolith, and the fragments were moved into the efferent Loop using scope push and saline flush methods. Here, we describe a case of Afferent Loop Syndrome caused by an enterolith that developed after Roux-en-Y hepaticojejunostomy and was treated with percutaneous transhepatic cholangio-enteroscopic lithotripsy

  • Percutaneous Cholangioscopic Lithotripsy for Afferent Loop Syndrome Caused by Enterolith Development after Roux-en-Y Hepaticojejunostomy: A Case Report
    Clinical endoscopy, 2013
    Co-Authors: Seong Hyun Kim, Seok Jeong, Don Haeng Lee, Sung Soo Yoo, Keon-young Lee
    Abstract:

    Afferent Loop obstruction caused by enterolith formation is rare and cannot be easily treated with endoscopy because of the difficulty associated with the nonsurgical removal of enteroliths. A 74-year-old woman was admitted with fever and acute abdominal pain. Clinical features and imaging studies suggested Afferent Loop obstruction caused by an enterolith after Roux-en-Y hepaticojejunostomy. Percutaneous transhepatic biliary drainage was initially performed because of severe cholangitis with septic shock. The enterolith was located in the jejunal limb adjacent to the hepaticojejunostomy site. Cholangioscopic lithotripsy was performed through the percutaneous transhepatic route to the enterolith, and the fragments were moved into the efferent Loop using scope push and saline flush methods. Here, we describe a case of Afferent Loop Syndrome caused by an enterolith that developed after Roux-en-Y hepaticojejunostomy and was treated with percutaneous transhepatic cholangio-enteroscopic lithotripsy.

Nadav Sahar – One of the best experts on this subject based on the ideXlab platform.

  • endoscopic ultrasound guided entero enterostomy for the treatment of Afferent Loop Syndrome a multicenter experience
    Endoscopy, 2018
    Co-Authors: Olaya Brewer I Gutierrez, Shayan Irani, Saowanee Ngamruengphong, Hanaa Dakour Aridi, Rastislav Kunda, Ali Siddiqui, Markus Dollhopf, Jose Nieto, Yeni Chen, Nadav Sahar
    Abstract:

    Background Afferent Loop Syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided enteroenterostomy (EUS-EE) has not been well described. The aim of this study was to assess the technical and clinical success and safety of EUS-EE. Methods This was a multicenter, retrospective series at six centers in patients with ALS treated by EUS-EE. Data on patients treated with enteroscopy-assisted luminal stenting (EALS) at a single center were also collected. Results 18 patients (mean age 64.2 years, 72 % post-pancreaticoduodenectomy, 10 female) underwent EUS-EE. The most common symptoms were vomiting (27.8 %) and jaundice (33.3 %). Clinical success included resolution of symptoms in 88.9 % and improvement to allow hospital discharge in 11.1 %. Technical success was achieved in 100 % of cases, with a mean procedure time of 29.7 minutes. The most common procedure was a gastro-jejunostomy (72.2 %). Three adverse events (16.7 %) occurred (two mild, one moderate). When compared with data on EALS, patients treated with EUS-EE needed fewer re-interventions (16.6 % vs. 76.5 %; P  Conclusion EUS-EE seems to be safe and effective in the treatment of ALS. Indirect comparison with EALS suggested that EUS-EE is associated with a reduced need for re-intervention.