title: Metallic stent insertion with double-balloon endoscopy for malignant afferent loop obstruction.
abstract: Progress in double-balloon endoscopy (DBE) has allowed for the diagnosis and treatment of disease in the postoperative bowel. For example, a short DBE, which has a 2.8 mm working channel and 152 cm working length, is useful for endoscopic retrograde cholangiopancreatography in bowel disease patients. However, afferent loop and Roux-limb obstruction, though rare, is caused by postoperative recurrence of biliary tract cancer with intractable complications. Most of the clinical findings involving these complications are relatively nonspecific and include abdominal pain, nausea, vomiting, fever, and obstructive jaundice. Treatments by surgery, percutaneous transhepatic biliary drainage, percutaneous enteral stent insertion, and endoscopic therapy have been reported. The general conditions of patients with these complications are poor due to cancer progression; therefore, a less invasive treatment is better. We report on the usefulness of metallic stent insertion using an overtube for afferent loop and Roux-limb obstruction caused by postoperative recurrence of biliary tract cancer under short DBE in two patients with complexly reconstructed intestines.
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Masakuni
authors.initials: M
authors.lastname: Fujii
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Ishiyama
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saito
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Ito
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Fujiwara
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Takefumi
authors.initials: T
authors.lastname: Niguma
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Yoshioka
authors.affiliation: Masakuni Fujii, Shuhei Ishiyama, Hiroaki Saito, Mamoru Ito, Akiko Fujiwara, Masao Yoshioka, Junji Shiode, Department of Internal Medicine, Okayama Saiseikai General Hospital, Okayama 700-8511, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Shiode
keywords: Afferent loop obstruction; Biliary tract cancer; Double balloon endoscopy; Metallic stent; Overtube