Treatment of Affluent Loop Syndrome with Laminopause and Metallic Stents None of the authors have nothing to disclose. We present a case of a 61-year-old female submitted to do adenopancreatectomy due to neuroendocrine tumor in 2009. Due to gastroparesis confirmed by gastric scintigraphy, patient was submitted to partial gastrectomy with gastrointestinal anastomosis after two years. In the eighth postoperative day, the patient presented bilious discharge from the surgical wand and underwent exploratory laparotomy, which demonstrated small loop perforation and hepatic fistula, both submitted to RAFIA. In the 13th postoperative day, the patient developed jaundice and abdominal CT scans showed significant dilation of biliopancreatic loop with an obstruction point. The patient underwent percutaneous transipatic drainage with jaundice improvements. At the 14th postoperative day, an endoscopy was performed showing partial gastrectomy with terminolateral gastrointestinal anastomosis and neuroendocrine anastomosis with no evidence of bile in the path and unsuccessful identification of biliodigestive anastomosis due to angulation of afferent loop. Using contrast injected by transparietal catheter, it was possible to identify a significant dilated biliopancreatic loop developed proximal to obstruction. A puncture was performed connecting the dilated segment of afferent loop with distal segment free of obstruction. The loop was filled with saline. And distal phalange was released in the dilated segment guided by an esacatorial echo endoscope. Proximal phalange was then successfully liberated in afferent loop segment distal to the obstruction. The biliopancreatic secretion was drained. Patient evolves uneventfully with improvement of bilirubin levels. The stent was removed six months after procedure maintaining anastomosis patency. Case presentation. A CT scan was performed showing dilated biliopancreatic loop proximal to obstruction point. Performed an endoscopy with evidence of a partial gastrectomy with gastrointestinal anastomosis without abnormalities. Afferent and efferent link was identified. The afferent link was explored with unsuccessful identification of bilidigestive anastomosis due to severe angulation. Enteroenteroanastomosis was accessed through efferent loop. Patient was then surgically anesthetized Patient was then submitted to echoguided enteroenteroanastomosis of the obstructed afferent loop using a 15 millimeters lens. Contrast was injected through transparietal drain showing dilated afferent loop in fluoroscopy. The echo endoscope was then introduced through afferent loop. The dilated afferent loop segment filled with saline through a transparietal drain was accessed by the echo endoscope. A 15 millimeters lens was introduced echoguided communicating both afferent loop segments. Proximal and distal phalange have successfully been released. Afterwards, a guide wire was introduced through stent lumen and a balloon catheter was used for dilation of the stent lumen up to 15 millimeters. Thank you for watching! After this procedure, a white drainage element with billy flow was created. Patient evolved uneventfully and percutaneous drain was removed 4 days after endoscopic drainage. She was then discharged 6 days after procedure with oral diet. 3 months after the procedure, a new endoscopy demonstrating the stent in place with white drainage orifice was performed. After 6 months, stent was removed with no evidence of leakage nor fistulas. New endoscopy was performed 1 month after stent removal. A substinosis was noticed in the endoscopic entorhintranastomosis. Performed dilation with balloon catheter up to 15 mm. In 18 months follow-up, no further dilations were necessary. In conclusion, treatment of Affirmed Loop Syndrome with lambs appears to be safe and effective, avoiding surgical intervention. Prospective studies are welcome to compare these results with surgical outcomes.

Affluent Loop Syndrome

Laminopause

Metallic Stents

Neuroendocrine Tumor

Gastroparesis