Liao ZL, Zeng JT, Dou L, Luo XZ. Staged percutaneous transhepatic cholangial drainage-assisted endoscopic ultrasound-guided gastrojejunostomy for afferent loop syndrome after pancreaticoduodenectomy: Two case reports. World J Gastrointest Endosc 2026; 18(10): 125483 [DOI: 10.4253/wjge.125483]
Corresponding Author of This Article
Xian-Zhang Luo, MD, Chongqing University Cancer Hospital, Chongqing University, No. 181 Hanyu Road, Shapingba District, Chongqing 400030, China. heroluoxz@sina.com
Research Domain of This Article
Surgery
Article-Type of This Article
case-report
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World J Gastrointest Endosc. Oct 16, 2026; 18(10): 125483 Published online Oct 16, 2026. doi: 10.4253/wjge.125483
Staged percutaneous transhepatic cholangial drainage-assisted endoscopic ultrasound-guided gastrojejunostomy for afferent loop syndrome after pancreaticoduodenectomy: Two case reports
Zhong-Li Liao, Jian-Ting Zeng, Lei Dou, Xian-Zhang Luo
Zhong-Li Liao, Department of Gastroenterology, Chongqing University Cancer Hospital, Chongqing 400030, China
Jian-Ting Zeng, Chongqing University Cancer Hospital, Chongqing 400030, China
Lei Dou, Hepatic Biliary and Pancreatic Cancer Center, Chongqing University Cancer Hospital, Chongqing 400030, China
Xian-Zhang Luo, Chongqing University Cancer Hospital, Chongqing University, Chongqing 400030, China
Author contributions: Liao ZL contributed to study concept and design; Dou L drafted the manuscript; Zeng JT revised the manuscript for important intellectual content; Luo XZ supervised the study; all authors approved the final manuscript.
AI contribution statement: The authors declare that no large language models or generative AI tools were used in the preparation, writing, or editing of this manuscript, nor in the analysis of the underlying data.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Received: July 14, 2026 Revised: August 6, 2026 Accepted: September 8, 2026 Published online: October 16, 2026 Processing time: 95 Days and 21.6 Hours
Abstract
BACKGROUND
Afferent loop syndrome (ALS) following pancreaticoduodenectomy (PD) is a rare but serious complication. Traditional management options carry significant limitations. This report describes a novel staged approach combining percutaneous transhepatic cholangial drainage (PTCD) with endoscopic ultrasound-guided gastrojejunostomy (EUS-GE) for the management of ALS.
CASE SUMMARY
We present two cases of ALS following PD. Case 1 involved a 57-year-old male with bile duct cancer who developed ALS 18 months post-PD. Case 2 involved a 50-year-old female with pancreatic duct adenocarcinoma who developed ALS 10 months post-PD. Both were managed with a novel staged approach: Initial PTCD for biliary decompression, followed by PTCD-assisted EUS-GE, where the existing tract was used to opacify and distend the collapsed afferent limb for precise targeting. Technical and clinical success was achieved in both cases. Symptoms associated with bile duct obstruction resolved in both patients following PTCD. Subsequently, PTCD-assisted EUS-GE was performed. Both patients resumed oral intake, had their PTCD catheters removed, and were discharged without complications. During 3 months’ follow-up, both patients-maintained patent stents without requirement for reintervention.
CONCLUSION
Staged PTCD/EUS-GE is a feasible and promising minimally invasive option for managing ALS following PD.
Core Tip: These case reports describe staged percutaneous transhepatic cholangial drainage-assisted endoscopic ultrasound-guided gastrojejunostomy for afferent loop syndrome after pancreaticoduodenectomy. By using the percutaneous transhepatic cholangial drainage access to distend and visualize the collapsed afferent limb, this technique overcomes the key technical limitation of conventional endoscopic ultrasound-guided gastrojejunostomy; difficulty in identifying the target loop. The approach achieved technical and clinical success in two cases, suggesting it is a feasible minimally invasive option warranting further evaluation.
