EUS-guided Jejunal-Jejunal anastomosis with LAMS as mini-invasive treatment for Malignant Afferent Loop Syndrome

Text A 79-year-old woman with Malignant Afferent Loop Syndrome (tumour recurrence at the gastro-jejunal anastomosis after Billroth II reconstruction) was referred to our Institute for EUS-guided Jejunal-Jejunal anastomosis between afferent (AL) and efferent (EL) loop in order to drain pancreatobiliary secretion into the jejunum, decreasing the bile reflux into the stomach. The AL was accessed from the EL using the electrocautery-enhanced delivery system of a 20-mm LAMS (Axios-EC) that was released under EUS and fluoroscopic control, resulting in a large amount of bile drained through the LAMS into the EL. Then, EUS-directed transenteric ERCP was performed with sphincterotomy and plastic biliary-pancreatic stenting.