Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jun 10, 2015; 7(6): 665-669
Published online Jun 10, 2015. doi: 10.4253/wjge.v7.i6.665
Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction
Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Takefumi Niguma, Masao Yoshioka, Junji Shiode
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.
Open-Access: 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/
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
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.

Keywords: Afferent loop obstruction, Double balloon endoscopy, Overtube, Metallic stent, Biliary tract cancer

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.