Ito Takashi, Shimatani Masaaki, Masuda Masataka, Nakamaru Koh, Mitsuyama Toshiyuki, Fukata Norimasa, Ikeura Tsukasa, Takaoka Makoto, Okazaki Kazuichi, Naganuma Makoto
The Third Department of Internal Medicine Division of Gastroenterology and Hepatology Kansai Medical University Osaka Japan.
Division of Gastroenterology and Hepatology Kansai Medical University Medical Center Osaka Japan.
DEN Open. 2022 Jul 22;3(1):e154. doi: 10.1002/deo2.154. eCollection 2023 Apr.
Afferent loop obstruction (ALO) is a rare mechanical complication that occurs after gastrojejunostomy. Recently the use of double-balloon endoscopy (DBE) can be useful for benign and malignant ALO.
We retrospectively identified 22 patients who underwent DBE for ALO from January 2009 to December 2020. We evaluated the efficacy and safety of short DBE treatment for ALO.
Short DBE was able to reach an obstructive site in the afferent limb in all patients (100%) and was able to reach the blind end in 14 patients (64%). The technical success rate was 100%, and the clinical success rate was 95%. Procedure-related adverse events occurred in two patients (9%). In the case of benign ALO, three of nine patients showed improvement in ALO with single stent placement. Two of nine patients improved after the replacement of the plastic stent (PS) two or three times. Four of nine patients continued with the replacement of PS. In the case of malignant ALO, the metallic stent was placed in 10 patients, and eight patients with metallic stents did not experience stent occlusion until they died. Reintervention was attempted in six patients (27%) with benign ALO but was not attempted in malignant ALO.
Treatments for ALO using the short DBE was effective and relatively safe because the technical and clinical success rates were very high and there were relatively low complications. Consequently, short DBE could be the first-choice treatment for both benign and malignant ALO.
输入袢梗阻（ALO）是胃空肠吻合术后发生的一种罕见机械性并发症。近来，双气囊内镜检查（DBE）对良性和恶性ALO均有帮助。
我们回顾性纳入了2009年1月至2020年12月期间因ALO接受DBE检查的22例患者。我们评估了短期DBE治疗ALO的有效性和安全性。
短期DBE在所有患者（100%）中均能到达输入袢的梗阻部位，在14例患者（64%）中能到达盲端。技术成功率为100%，临床成功率为95%。两名患者（9%）发生了与操作相关的不良事件。在良性ALO病例中，9例患者中有3例通过单次放置支架使ALO得到改善。9例患者中有2例在两到三次更换塑料支架（PS）后病情改善。9例患者中有4例继续更换PS。在恶性ALO病例中，10例患者放置了金属支架，8例放置金属支架的患者直至死亡都未发生支架堵塞。6例（27%）良性ALO患者尝试了再次干预，但恶性ALO患者未尝试。
使用短期DBE治疗ALO是有效且相对安全的，因为技术成功率和临床成功率都很高，并发症相对较少。因此，短期DBE可以作为良性和恶性ALO的首选治疗方法。
