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- Drainage for fluid collections post pancreatic surgery and acute pancreatitis: similar but different?
- Yousuke Nakai, Saburo Matsubara, Tsuyoshi Mukai, Tsuyoshi Hamada, Takashi Sasaki, Hirotoshi Ishiwatari, Susumu Hijioka, Hideyuki Shiomi, Mamoru Takenaka, Takuji Iwashita, Atsuhiro Masuda, Tomotaka Saito, Hiroyuki Isayama, Ichiro Yasuda, for the WONDERFUL study group in Japan
- Clin Endosc 2024;57(6):735-746. Published online May 17, 2024
- DOI: https://doi.org/10.5946/ce.2023.254
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Abstract
PDF
PubReader
ePub - Postoperative pancreatic fistulas (POPFs) are common adverse events that occur after pancreatic surgery. Endoscopic ultrasonography (EUS)-guided drainage (EUS-D) is a first-line treatment, similar to that for pancreatic fluid collection (PFCs) after acute pancreatitis. However, some POPFs do not develop fluid collections depending on the presence or location of the surgical drain, whereas others develop fluid collections, such as postoperative fluid collections (POPFCs). Although POPFCs are similar to PFCs, the strategy and modality for POPF management need to be modified according to the presence of fluid collections, surgical drains, and surgical type. As discussed for PFCs, the indications, timing, and selection of interventions or stents for EUS-D have not been fully elucidated for POPFs. In this review, we discuss the management of POPFs and POPFCs in comparison with PFCs due to acute pancreatitis and summarize the topics that should be addressed in future studies.
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Citations
Citations to this article as recorded by
- EUS-TD With Multiple Plastic Stents for Postoperative Pancreatic Fistula
Koichiro Miyagawa, Shinji Oe, Yasuhisa Mori, Tsuyoshi Ueda, Nobuhiko Shinohara, Kosuke Hideshima, Yudai Koya, Yuichi Honma, Masaru Harada
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2026;[Epub] CrossRef - Clinical Outcomes and Risk Factors for Adverse Events Associated With Endoscopic Ultrasound‐Guided Drainage of Postoperative Pancreatic Fluid Collections Following Distal Pancreatectomy
Ho Seung Lee, Gunn Huh, Yoonchan Lee, Sung Hyun Cho, Jae Min Lee, Tae Jun Song, Dong‐Wan Seo, Dongwook Oh
Journal of Gastroenterology and Hepatology.2026; 41(3): 1021. CrossRef - Management of Postoperative Pancreatic Fluid Collection and Role of Endoscopy: A Case Series and Review of the Literature
Chiara Coluccio, Ilaria Tarantino, Maria Chiara Petrone, Edoardo Forti, Stefano Francesco Crinò, Alessandro Fugazza, Roberto Di Mitri, Cecilia Binda, Davide Trama, Arnaldo Amato, Alessandro Redaelli, Germana De Nucci, Fabia Attili, Mario Luciano Brancacci
Diagnostics.2025; 15(10): 1258. CrossRef - Percutaneous mini–invasive interventions in the treatment of peripancreatic fluid accumulation after pancreatic resection
M. V. Kostylev, V. P. Shkarban, V. I. Trachuk, V. O. Shatalo
The Ukrainian Journal of Clinical Surgery.2025; 92(3): 20. CrossRef - Acute Necrotizing Pancreatitis—Advances and Challenges in Management for Optimal Clinical Outcomes
Ioana Dumitrascu, Narcis Octavian Zarnescu, Eugenia Claudia Zarnescu, Mihai Radu Pahomeanu, Alexandru Constantinescu, Dana Galieta Minca, Radu Virgil Costea
Medicina.2025; 61(7): 1186. CrossRef - Endoscopic ultrasound-guided drainage of a right liver fistula caused by percutaneous thermoablation
Angelica Toppeta, Jean-Philippe Ratone, Solene Hoibian, Yanis Dahel, Antoine Assaf, Marc Giovannini, Fabrice Caillol
Endoscopy.2025; 57(S 01): E788. CrossRef
- EUS-TD With Multiple Plastic Stents for Postoperative Pancreatic Fistula
- 14,419 View
- 529 Download
- 5 Web of Science
- 6 Crossref
Original Article
- A novel fully covered metal stent for unresectable malignant distal biliary obstruction: results of a multicenter prospective study
- Arata Sakai, Atsuhiro Masuda, Takaaki Eguchi, Keisuke Furumatsu, Takao Iemoto, Shiei Yoshida, Yoshihiro Okabe, Kodai Yamanaka, Ikuya Miki, Saori Kakuyama, Yosuke Yagi, Daisuke Shirasaka, Shinya Kohashi, Takashi Kobayashi, Hideyuki Shiomi, Yuzo Kodama
- Clin Endosc 2024;57(3):375-383. Published online July 10, 2023
- DOI: https://doi.org/10.5946/ce.2023.035
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Graphical Abstract
Abstract
PDF
Supplementary MaterialPubReaderePub - Background
/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO.
Methods
This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events.
Results
A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration.
Conclusions
The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration. -
Citations
Citations to this article as recorded by- Percutaneous metallic stent placement for malignant extrahepatic biliary obstruction: single-center experience in 612 patients
Jihoon Kim, Dong Il Gwon, Jeongyeon Kim, Eunbyeol Ko, Jin Hyoung Kim, Gi-Young Ko, Hyun-Ki Yoon
Acta Radiologica.2026; 67(4): 352. CrossRef - Clinical Outcomes and Complications of Endoscopic Biliary Stenting for Malignant Distal Biliary Obstruction in Pancreatic Cancer: A Systematic Review
Nurken Abdiyev, Nurlan Jaxymbayev, Melis Maira, Medet Rakhmetov, Almas Ismailov, Abdykadyrov Mazhit, Yerlan Abdirashev, Berik Dzhumabekov
Journal of Clinical Medicine.2026; 15(8): 3126. CrossRef - The anti‐migration effect of partially covered self‐expandable metal stents for unresectable malignant distal biliary obstruction: A multicenter comparative study
Shinya Kohashi, Arata Sakai, Keisuke Furumatsu, Takeshi Ezaki, Takao Iemoto, Takeshi Tanaka, Masahiro Tsujimae, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
DEN Open.2025;[Epub] CrossRef - Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
Gastroenterology Report.2025;[Epub] CrossRef - From dogma to individualized care: the potential of 6-mm fully covered self-expandable metal stent in unresectable malignant distal biliary obstruction
Hyung Ku Chon
Clinical Endoscopy.2025; 58(4): 630. CrossRef - Advancements in stent strategies for malignant distal biliary obstruction: defining the clinical role of multi-hole self-expandable metal stents
Sung Yong Han
Clinical Endoscopy.2025; 58(5): 698. CrossRef - Endeavors to prevent stent malfunction: new insights into the risk factors for recurrent biliary obstruction
Sung-Jo Bang
Clinical Endoscopy.2024; 57(1): 56. CrossRef - Understanding mechanical properties of biliary metal stents for wise stent selection
Seok Jeong
Clinical Endoscopy.2023; 56(5): 592. CrossRef
- Percutaneous metallic stent placement for malignant extrahepatic biliary obstruction: single-center experience in 612 patients
- 8,367 View
- 134 Download
- 7 Web of Science
- 8 Crossref
Editorial
- Covered self-expandable metal stents for distal biliary obstruction from pancreatic carcinoma: what type of stent is preferred?
- Hideyuki Shiomi, Ryota Nakano, Shogo Ota
- Clin Endosc 2022;55(3):369-371. Published online May 11, 2022
- DOI: https://doi.org/10.5946/ce.2022.122
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PDFPubReaderePub
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Citations
Citations to this article as recorded by- Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
Jung Won Chun, Woo Hyun Paik, Sang Myung Woo, Jin Ho Choi, In Rae Cho, Woo Jin Lee, Ji Kon Ryu, Yong-Tae Kim, Sang Hyub Lee
Gastroenterology Report.2025;[Epub] CrossRef - A case of delayed pancreatic fistula after covered self-expandable metallic stent deployment for pancreatic head cancer
Shogo Ota, Hideyuki Shiomi, Ryota Nakano, Takashi Nishimura, Hirayuki Enomoto, Hiroko Iijima
Clinical Journal of Gastroenterology.2023; 16(2): 303. CrossRef - Endoscopic ultrasound-guided biliary drainage for distal malignant biliary obstruction: a prospective 3-year multicenter Egyptian study
K.M. Ragab, M Abdel-Hameed, M Gouda, H Katamish, A Madkour, H Atalla, H Hamed, G.E. Shiha, O Abdallah, R.H. Agwa, E Ghoneem
Acta Gastro Enterologica Belgica.2023; 86(1): 26. CrossRef
- Prevention of stent migration of covered self-expandable metal stents in distal malignant biliary obstruction: a review of literature
- 4,628 View
- 158 Download
- 3 Web of Science
- 3 Crossref
Focused Review Series: Endoscopic Management of Postoperative Gastrointestinal Complication: What’s New?
- Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
- Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
- Clin Endosc 2021;54(6):810-817. Published online November 15, 2021
- DOI: https://doi.org/10.5946/ce.2021.234
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Abstract
PDFPubReaderePub
- Afferent loop syndrome (ALS) is a mechanical obstruction of the afferent limbs after gastrectomy with gastrojejunostomy reconstruction. Patients with cancer recurrence require immediate and less invasive treatment because of their poor condition. Percutaneous transhepatic/transluminal drainage (PTD) and endoscopic enteral stenting offer reasonable palliative treatment for malignant ALS but are not fully satisfactory in terms of patient quality of life (QoL) and stent patency. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) using a lumen-apposing metal stent may address these shortcomings. Clinical data from 11 reports showed that all patients who had undergone EUS-GE had positive technical and clinical outcomes. The adverse event rate was 11.4%, including only mild or moderate abdominal pain, with no severe adverse events. Indirect comparative studies indicated that patients who had undergone EUS-GE had a significantly superior QoL, a higher clinical success rate, and a lower reintervention rate than those who had undergone PTD or endoscopic enteral stenting. Although the evidence is limited, EUS-GE may be considered as a first-line treatment for malignant ALS because it has better clinical outcomes than other less invasive treatments, such as PTD or endoscopic enteral stenting. Further prospective randomized control trials are necessary to establish EUS-GE as a standard treatment for ALS.
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Citations
Citations to this article as recorded by- Role of Endoscopic Ultrasound‐guided Gastroenterostomy for Benign Gastric Outlet Obstruction
Suprabhat Giri, Saroj Kanta Sahu, Gaurav Khatana, Prasanna Gore, Preetam Nath, Bipadabhanjan Mallick, Jimmy Narayan, Aditya Kale, Sridhar Sundaram
DEN Open.2026;[Epub] CrossRef - Benign case of afferent loop syndrome after subtotal gastrectomy: endoscopic ultrasound-guided jejunojejunostomy for rescue
Jahnvi Dhar, Sanish Ancil, Jayanta Samanta
Clinical Endoscopy.2026; 59(1): 144. CrossRef - One-step EUS–guided gastrojejunostomy for the treatment of a case of afferent loop syndrome (with video)
Guoyao Sun, Wanting Wang, Jiao Liu, Yong Sun, Zhuo Yang
Endoscopic Ultrasound.2026; 15(1): 82. CrossRef - Endoscopic ultrasound-guided gastroenterostomy, with focus on technique and practical tips
Chi-Ying Yang, Wen-Hsin Huang, Hsing-Hung Cheng
Clinical Endoscopy.2025; 58(2): 201. CrossRef - Enteroscopic direct drainage for submucosal intestinal juice leakage due to afferent loop syndrome in Roux-en-Y anatomy
Mitsuru Okuno, Tsuyoshi Mukai, Fumiya Kataoka, Hiroshi Araki, Eiichi Tomita, Hisataka Moriwaki, Masahito Shimizu
Endoscopy.2025; 57(S 01): E866. CrossRef - Interventional endosonography comes of age: an update on endoscopic ultrasonography-guided drainage and anastomosis procedures
Tiing Leong Ang, Christopher Jen Lock Khor
Singapore Medical Journal.2025; 66(8): 420. CrossRef - Endoscopic ultrasound‐guided gastrointestinal anastomosis: Are we there yet?
Vinay Dhir, Cesar Jaurrieta‐Rico, Vivek Kumar Singh
Digestive Endoscopy.2024; 36(9): 981. CrossRef - Endoscopic ultrasound-guided gastroenterostomy using a novel dumbbell-shaped fully covered metal stent for afferent loop syndrome with long interluminal distance
Hideyuki Shiomi, Ryota Nakano, Shogo Ota, Hiroko Iijima
Endoscopy.2023; 55(S 01): E362. CrossRef - Endoscopic Ultrasound-Guided Gastrojejunostomy for Malignant Afferent Loop Syndrome Using a Fully Covered Metal Stent: A Multicenter Experience
Saburo Matsubara, Sho Takahashi, Naminatsu Takahara, Keito Nakagawa, Kentaro Suda, Takeshi Otsuka, Yousuke Nakai, Hiroyuki Isayama, Masashi Oka, Sumiko Nagoshi
Journal of Clinical Medicine.2023; 12(10): 3524. CrossRef - Endoscopic ultrasound guided gastroenterostomy: Technical details updates, clinical outcomes, and adverse events
Jian Wang, Jin-Long Hu, Si-Yu Sun
World Journal of Gastrointestinal Endoscopy.2023; 15(11): 634. CrossRef - Endoscopic ultrasound-guided intra-afferent loop entero-enterostomy using a forward-viewing echoendoscope and insertion of a metal stent
Yuki Kawasaki, Susumu Hijioka, Kosuke Maehara, Kiichi Tamada, Takuji Okusaka, Yutaka Saito
Endoscopy.2022; 54(S 02): E815. CrossRef - Endoscopic ultrasound‐guided gastrojejunostomy for malignant afferent loop syndrome with hemorrhage in a patient with recurrent peritoneal dissemination
Kenjiro Yamamoto, Takayoshi Tsuchiya, Ryosuke Tonozuka, Shuntaro Mukai, Hiroyuki Kojima, Noriyuki Hirakawa, Takao Itoi
Journal of Hepato-Biliary-Pancreatic Sciences.2022;[Epub] CrossRef - Current status of, and challenges posed by, endoscopic ultrasound‐guided anastomosis of the digestive tract in patients with afferent loop syndrome
Toshio Fujisawa, Hiroyuki Isayama
Digestive Endoscopy.2022; 34(7): 1440. CrossRef
- Role of Endoscopic Ultrasound‐guided Gastroenterostomy for Benign Gastric Outlet Obstruction
- 7,695 View
- 185 Download
- 14 Web of Science
- 13 Crossref
Case Report
- Endoscopic Self-Expandable Metal Stent Placement for Malignant Afferent Loop Obstruction After Pancreaticoduodenectomy: A Case Series and Review
- Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
- Clin Endosc 2020;53(4):491-496. Published online March 3, 2020
- DOI: https://doi.org/10.5946/ce.2019.145
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Abstract
PDFPubReaderePub
- In this study, we assessed a series of our cases in which endoscopic self-expandable metal stents (SEMSs) were used to treat malignant afferent loop obstruction (ALO) that arose after pancreaticoduodenectomy (PD). We retrospectively examined the records of 7 patients who underwent endoscopic SEMS placement for malignant ALO following PD. Clinical success was achieved in all cases. The median procedure time was 30 min (range, 15–50 min). There were no cases of stent occlusion, and no procedure-related adverse events were encountered. All patients died of their primary disease, and the median overall survival period was 155 days (range, 96–374 days). A re-intervention involving endoscopic ultrasound-guided hepaticogastrostomy combined with antegrade stenting was performed for obstructive jaundice and acute cholangitis in 1 case. In conclusion, endoscopic SEMS placement may be an effective and safe treatment for malignant ALO that arises after PD.
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Citations
Citations to this article as recorded by- PTCD-stent complex for recurrent malignant afferent loop obstruction after pancreaticoduodenectomy
Dongxue Geng, Yi Miao, Jingjing Tao
BMC Surgery.2026;[Epub] CrossRef - Endoscopic ultrasound-guided gastrointestinal anastomoses for the treatment of afferent limb syndrome: a systematic review and meta-analysis
Giacomo Emanuele Maria Rizzo, Giuseppe Vanella, Lorenzo Fuccio, Antonio Facciorusso, Stefano Mazza, Fausto Catena, Carlo Fabbri, Andrea Anderloni, Ilaria Tarantino
Surgical Endoscopy.2026;[Epub] CrossRef - Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review
Kenjiro Yamamoto, Takao Itoi, Yukitoshi Matsunami, Atsushi Sofuni, Takayoshi Tsuchiya, Shuntaro Mukai, Hiroyuki Kojima, Hirohito Minami, Ryosuke Nakatsubo, Ryosuke Tonozuka
Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(2): 120. CrossRef - Efficacy of endoscopic ultrasound‐guided gastroenterostomy using self‐expandable metallic stent for afferent loop syndrome: A single‐center retrospective study
Yuya Hagiwara, Susumu Hijioka, Yoshikuni Nagashio, Yuta Maruki, Akihiro Ohba, Yuki Kawasaki, Kotaro Takeshita, Tetsuro Takasaki, Daiki Agarie, Hidenobu Hara, Shin Yagi, Soma Fukuda, Masaru Kuwada, Daiki Yamashige, Kohei Okamoto, Mark Chatto, Shunsuke Kond
Journal of Gastroenterology and Hepatology.2024; 39(10): 2136. CrossRef - Successful metal stent placement using short single-balloon endoscope for afferent loop syndrome after pancreaticoduodenectomy
Takuto Furukawa, Yuichi Takano, Jun Noda, Masataka Yamawaki, Tetsushi Azami, Fumitaka Niiya, Fumiya Nishimoto, Naotaka Maruoka, Masatsugu Nagahama
Progress of Digestive Endoscopy.2024; 104(1): 98. CrossRef - Antegrade metallic stent placement using a slim cholangioscope for malignant afferent loop obstruction
Haruo Miwa, Ritsuko Oishi, Kazuki Endo, Hiromi Tsuchiya, Akihiro Funaoka, Yuichi Suzuki, Shin Maeda
Endoscopy.2024; 56(S 01): E774. CrossRef - The Role of Endoscopic Management in Afferent Loop Syndrome
Clement Chun Ho Wu, Elizabeth Brindise, Rami El Abiad, Mouen A. Khashab
Gut and Liver.2023; 17(3): 351. CrossRef - Simultaneous stent placement for biliary and afferent loop obstruction due to tumor recurrence after pancreatoduodenectomy
Tatsunori Satoh, Hirotoshi Ishiwatari, Kazuma Ishikawa, Hidenori Kimura, Hiroyuki Matsubayashi, Hiroyuki Ono
Endoscopy.2022; 54(09): E524. CrossRef - Extra-anatomic percutaneous stenting of a malignant afferent loop obstruction following pancreaticoduodenectomy
Stefan Lam, Sarah Khan, Robert Hutchins, Tim Fotheringham
International Journal of Gastrointestinal Intervention.2022; 11(2): 77. CrossRef - Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Journal of Clinical Medicine.2022; 11(21): 6357. CrossRef - Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 684. CrossRef - Clinical management for malignant afferent loop obstruction
Arata Sakai, Hideyuki Shiomi, Atsuhiro Masuda, Takashi Kobayashi, Yasutaka Yamada, Yuzo Kodama
World Journal of Gastrointestinal Oncology.2021; 13(7): 509. CrossRef - Endoscopic Ultrasound-Guided Gastroenterostomy for Afferent Loop Syndrome
Hideyuki Shiomi, Arata Sakai, Ryota Nakano, Shogo Ota, Takashi Kobayashi, Atsuhiro Masuda, Hiroko Iijima
Clinical Endoscopy.2021; 54(6): 810. CrossRef - Percutaneous- and EUS-guided gastroenterostomy for malignant afferent limb syndrome
Dayyan Adoor, Zachary L. Smith
VideoGIE.2020; 5(11): 542. CrossRef
- PTCD-stent complex for recurrent malignant afferent loop obstruction after pancreaticoduodenectomy
- 7,366 View
- 120 Download
- 11 Web of Science
- 14 Crossref
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