Clinical management for malignant afferent loop obstruction

Figure 1 A computed tomography scan. A: Distention of the afferent loop by a recurrent tumor; B: Biliary dilation; C: Coronal section.

Figure 2 Therapeutic schemas for malignant afferent loop obstruction. A: Treatment of malignant afferent loop obstruction (ALO) with obstructive jaundice by percutaneous transhepatic biliary drainage; B: Treatment of malignant ALO by direct percutaneous afferent loop drainage; C: Treatment of malignant ALO by endoscopic transluminal self-expandable metal stent; D: Treatment of malignant ALO by endoscopic ultrasound-guided gastrojejunostomy.

Figure 3 Endoscopic transluminal self-expandable metal stent for malignant afferent loop obstruction. A: Neoplastic stenosis in the afferent loop blocked further passage of the endoscope; B: The stenosis was confirmed with contrast media; C: Self-expandable metal stent was placed by the standard through-the-scope technique under fluoroscopic view; D: Endoscopic view.

Figure 4 Endoscopic ultrasound-guided gastrojejunostomy for malignant afferent loop obstruction. A: Endoscopic ultrasound (EUS) shows the dilated afferent loop; B: Dilated afferent loop was punctured using a 19G FNA needle with an EUS guide; C: Self-expandable metal stent was placed using the standard through-the-scope technique under fluoroscopic view; D: Endoscopic view.