title: Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience.
abstract: BACKGROUND
  There are limited data on the incidence of afferent limb syndrome and other delayed GI problems in pancreatic cancer (PaC) patients, especially among long-term survivors (>2 years).
  
  
  OBJECTIVE
  To evaluate the incidence of afferent limb syndrome (chronic afferent limb obstruction resulting in pancreatobiliary obstruction) and delayed GI problems in PaC patients after pancreaticoduodenectomy (PD).
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  PaC patients treated with PD (N = 186) over a 14-year period (January 1995-October 2009).
  
  
  METHODS
  Endoscopic balloon dilation and stent placement, percutaneous biliary drainage.
  
  
  METHODS
  Incidence of afferent limb syndrome and delayed GI complications (marginal ulcers, radiation enteropathy, anastomotic strictures).
  
  
  RESULTS
  Mean age was 63 ± 10 years; 55% of patients were male. Afferent limb syndrome was noted in 24 patients (13%). Median time to diagnosis was 1.2 years (range 0.03-12.3 years); obstruction was primarily caused by recurrent PaC (8 patients, 33%) and radiation enteropathy (9 patients, 38%). Afferent limb syndrome was more likely to develop in patients with 2 years or longer of follow-up (n = 71, [38%]) compared with patients with 2 years or less of follow-up, after controlling for age, sex, surgery type, and adjuvant treatment (adjusted odds ratio, 4.5; 95% CI, 1.8-11.7). Other delayed GI problems included radiation enteropathy (6%), marginal ulcers (5%), anastomotic strictures (4%), cholangitis/liver abscesses (5%), and GI bleeding (6%).
  
  
  CONCLUSIONS
  Retrospective, single-center study.
  
  
  CONCLUSIONS
  GI problems, including afferent limb syndrome, are relatively common in PaC patients after surgery and adjuvant therapy. Clinicians should recognize and effectively treat these delayed GI problems, especially in long-term survivors.
authors.affiliation: Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Pannala
authors.forename: John J
authors.initials: JJ
authors.lastname: Brandabur
authors.forename: Seng-Ian
authors.initials: SI
authors.lastname: Gan
authors.forename: Michael
authors.initials: M
authors.lastname: Gluck
authors.forename: Shayan
authors.initials: S
authors.lastname: Irani
authors.forename: David J
authors.initials: DJ
authors.lastname: Patterson
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Ross
authors.forename: Russell
authors.initials: R
authors.lastname: Dorer
authors.forename: L William
authors.initials: LW
authors.lastname: Traverso
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Picozzi
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kozarek
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000343:Afferent Loop Syndrome / Q000209:etiology* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002404:Catheterization; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D004322:Drainage; D005260:Female; D006801:Humans; D007422:Intestines / Q000473:pathology / Q000528:radiation effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000628:therapy*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011832:Radiation Injuries / Q000150:complications*; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014456:Ulcer / Q000209:etiology / Q000473:pathology