Endoscopic ultrasound-guided entero-enterostomy for the treatment of afferent loop syndrome: a multicenter experience.

Background: Afferent loop syndrome (ALS) is traditionally managed surgically and, more recently, endoscopically. The role of endoscopic ultrasound-guided entero-enterostomy (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  < 0.001).
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.
Competing Interests: Shayan S. Irani is a consultant for Boston Scientific. Rastislav Kunda is a medical advisory board, consultant and speaker for Boston Scientific, consultant for BCM Korea, Omega Medical Imaging, and Olympus Japan. Mark Dollhopf is a consultant for Boston Scientific. Jose Nieto is a consultant for Boston Scientific and Medtronic. Vikesh K. Singh is a consultant for Abbvie, Novo Nordisk, and Ariel and advisory board participant for Nordmark. Richard Kozarek receives research support from Boston Scientific. Mouen A. Khashab is a consultant for Boston Scientific and Olympus.
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