Gastrointestinal Intervention  2016;5(2):129-137

doi:10.18528/gii160019

The obstructed afferent loop: Percutaneous options.

Damian MULLAN 1 ; Raman UBEROI

Affiliations

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Keywords

Afferent loop syndrome; Bile ducts; Biliary tract neoplasms; Percutaneous stents; Self expandable metal stents

Country

Republic of Korea

Language

English

Abstract

Endoscopic drainage can be considered the treatment of choice in benign and malignant obstruction of the distal biliary tree, with percutaneous intervention reserved for cases of difficult access or complex hilar strictures. However in patients with altered anatomy due to pancreatico-duodenectomy gastrectomy, or Bilroth II reconstruction, endoscopy can be exceptionally challenging and often impossible. Surgery remains the gold standard for benign causes of obstruction of a bilio-enteric anastomosis or afferent loop, and percutaneous management remains controversial. Novel endoscopic techniques such as double balloon enteroscopy and endoscopic ultrasound guided procedures can overcome some of the anatomical challenges, but a percutaneous approach is a more established technique for cases of malignant obstruction of a bilio-enteric anastomosis or afferent loop. The altered anatomy presents unique challenges which must be fully contemplated and understood before intervention should occur, to avoid the risk of permanent external drainage.