title: Enteral stenting for gastric outlet obstruction and afferent limb syndrome following pancreaticoduodenectomy.
abstract: BACKGROUND
  Obstruction of the afferent or efferent limbs of a gastrojejunal anastomosis is a potential complication after pancreaticoduodenectomy (PD) resulting in either gastric outlet obstruction or afferent limb syndrome. The use of self-expanding metal stents for the management of anastomotic strictures after resection of pancreatic cancer has not been well studied. We present four such cases and review published data regarding this population.
  
  
  METHODS
  Retrospective chart review and literature search. Outcomes were summarized with descriptive statistics.
  
  
  RESULTS
  At our institution, 4 patients underwent metal stent placement for gastrojejunal obstruction after PD for pancreatic cancer. Enteral stents were placed in two patients across the afferent limb, in one patient across the efferent limb, and in another patient across both limbs. Similar cases in the literature revealed that the anastomotic stricture was malignant in 26 of 27 cases. Clinical improvement occurred in 88%. Afferent limb syndrome was successfully treated in 5 of 6 cases. Median survival was 3.5 months after stent placement.
  
  
  CONCLUSIONS
  Effective palliation of both gastric outlet obstruction and afferent limb syndrome after PD can be provided with enteral stenting. Gastrojejunal strictures after PD for pancreatic cancer are usually malignant with median survival of 3.5 months after stent placement.
authors.affiliation: Division of Gastroenterology, (Wilson T. Kwong, Syed M. Fehmi, Thomas J. Savides), University of California San Diego Health Sciences, San Diego, CA, USA.
authors.forename: Wilson T
authors.initials: WT
authors.lastname: Kwong
authors.affiliation: Division of Gastroenterology, (Wilson T. Kwong, Syed M. Fehmi, Thomas J. Savides), University of California San Diego Health Sciences, San Diego, CA, USA.
authors.forename: Syed M
authors.initials: SM
authors.lastname: Fehmi
authors.affiliation: Division of Surgical Oncology (Andrew M. Lowy), University of California San Diego Health Sciences, San Diego, CA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lowy
authors.affiliation: Division of Gastroenterology, (Wilson T. Kwong, Syed M. Fehmi, Thomas J. Savides), University of California San Diego Health Sciences, San Diego, CA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
keywords: Stent; afferent limb syndrome; gastric outlet obstruction; pancreatic cancer; pancreaticoduodenectomy