Published online Nov 6, 2020. doi: 10.12998/wjcc.v8.i21.5353
Peer-review started: March 27, 2020
First decision: September 24, 2020
Revised: September 27, 2020
Accepted: October 1, 2020
Article in press: October 1, 2020
Published online: November 6, 2020
Processing time: 223 Days and 23.3 Hours
Afferent loop syndrome (ALS) is a rare mechanical complication that occurs after reconstruction of the stomach or esophagus to the jejunum, such as Billroth II gastrojejunostomy, Roux-en-Y gastrojejunostomy, or Roux-en-Y esophagoje-junostomy. Traditionally, an operation is the first choice for benign causes. However, for patients in poor physical condition who experience ALS soon after R0 resection, the type of treatment remains controversial. Here, we present an efficient conservative method to treat ALS.
Case 1 was a 69-year-old male patient who underwent total gastrectomy with Roux-en-Y jejunojejunostomy. On postoperative day (POD) 10 he developed symptoms of ALS that persisted and increased over 1 wk. Case 2 was a 59-year-old male patient who underwent distal gastrectomy with Billroth II gastrojejunostomy. On postoperative day POD 9 he developed symptoms of ALS that persisted for 2 wk. Both patients underwent fluoroscopic-guided nasointestinal tube placement with maintenance of continuous negative pressure suction. Approximately 20 d after the procedure, both patients had recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, there were no signs of ALS in these two patients.
This is the first report of treating postoperative ALS by fluoroscopic-guided nasointestinal tube placement. Our cases demonstrate that this procedure is an effective and safe method to treat ALS that relieves patients’ symptoms and avoids complications caused by other invasive procedures.
Core Tip: Afferent loop syndrome (ALS) is a rare complication following recon-struction of the stomach or esophagus to the jejunum. Traditionally, surgery is the cornerstone of treatment. However, for patients in poor physical condition who develop ALS soon after the operation, a secondary surgery may not be appropriate. Here, we present two patients who were successfully treated with fluoroscopic-guided nasointestinal tube placement without stent insertion or surgery. With continuous negative pressure suction for approximately 20 d, both patients recovered well and were discharged from hospital after removal of the tube. At 3-mo follow-up, the patients showed no symptoms of ALS.