Hu HT, Ma FH, Wu ZM, Qi XH, Zhong YX, Xie YB, Tian YT. Treatment of afferent loop syndrome using fluoroscopic-guided nasointestinal tube placement: Two case reports. World J Clin Cases 2020; 8(21): 5353-5360 [PMID: 33269270 DOI: 10.12998/wjcc.v8.i21.5353]
Corresponding Author of This Article
Yan-Tao Tian, MD, PhD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
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/
Hai-Tao Hu, Fu-Hai Ma, Yu-Xin Zhong, Yi-Bin Xie, Yan-Tao Tian, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Zhen-Min Wu, Xiu-Heng Qi, Department of Oncology, Hebei Petro China Central Hospital, Langfang 065000, Hebei Province, China
Author contributions: Hu HT collected and analyzed the data and drafted the manuscript; Wu ZM and Zhong YX provided clinical data; Tian YT and Qi XH designed the outline of the manuscript; Ma FH and Xie YB modified the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported byNational Natural Science Foundation of China, No. 81772642; Capital’s Funds for Health Improvement and Research, No. CFH2018-2-4022; and Wu Jieping Medical Foundation, No. 320.6750.15276.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declared that they have no conflicts of interest to this work.
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).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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/
Corresponding author: Yan-Tao Tian, MD, PhD, Professor, Surgeon, Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. tianyantao@cicams.ac.cn
Received: March 27, 2020 Peer-review started: March 27, 2020 First decision: September 24, 2020 Revised: September 27, 2020 Accepted: October 1, 2020 Article in press: October 1, 2020 Published online: November 6, 2020
Abstract
BACKGROUND
Afferent loop syndrome (ALS) is a rare mechanical complication that occurs after reconstruction of the stomach or esophagus to the jejunum, such as Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagoje-junostomy. Traditionally, an operation is the first choice for benign causes. However, for patients in poor physical condition who experience ALS soon after R0 resection, the type of treatment remains controversial. Here, we present an efficient conservative method to treat ALS.
CASE SUMMARY
Case 1 was a 69-year-old male patient who underwent total gastrectomy with Roux-en-Y jejunojejunostomy. On postoperative day (POD) 10 he developed symptoms of ALS that persisted and increased over 1 wk. Case 2 was a 59-year-old male patient who underwent distal gastrectomy with Billroth II gastrojejunostomy. On postoperative day POD 9 he developed symptoms of ALS that persisted for 2 wk. Both patients underwent fluoroscopic-guided nasointestinal tube placement with maintenance of continuous negative pressure suction. Approximately 20 d after the procedure, both patients had recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, there were no signs of ALS in these two patients.
CONCLUSION
This is the first report of treating postoperative ALS by fluoroscopic-guided nasointestinal tube placement. Our cases demonstrate that this procedure is an effective and safe method to treat ALS that relieves patients’ symptoms and avoids complications caused by other invasive procedures.
Core Tip: Afferent loop syndrome (ALS) is a rare complication following recon-struction of the stomach or esophagus to the jejunum. Traditionally, surgery is the cornerstone of treatment. However, for patients in poor physical condition who develop ALS soon after the operation, a secondary surgery may not be appropriate. Here, we present two patients who were successfully treated with fluoroscopic-guided nasointestinal tube placement without stent insertion or surgery. With continuous negative pressure suction for approximately 20 d, both patients recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, the patients showed no symptoms of ALS.
