{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:42:38Z","timestamp":1791639758244,"version":"4.3.4"},"reference-count":16,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2022,5,31]],"date-time":"2022-05-31T00:00:00Z","timestamp":1653955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Endoscopic ultrasound\u2010guided digestive anastomosis (EUS\u2010A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS\u2010A in ALS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is an observational multicenter study. All patients \u226518\u2009years old with previous Whipple surgery presenting with ALS who underwent an EUS\u2010A using a lumen\u2010apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS\u2010related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Forty\u2010five patients (mean age: 65.5\u2009\u00b1\u200910.2\u2009years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS\u2010A was performed at a median of 6\u2009weeks after local tumor recurrence. The most common approach used was the direct\/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (\u226515\u2009mm) and small LAMS (97.4% vs. 100%, <jats:italic>P<\/jats:italic>\u2009=\u20090.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure\u2010related adverse events (4.4%) after a median follow\u2010up of 4\u2009months. Twenty\u2010six patients (57.8%) died during the follow\u2010up due to disease progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>EUS\u2010A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.14330","type":"journal-article","created":{"date-parts":[[2022,4,16]],"date-time":"2022-04-16T16:40:25Z","timestamp":1650127225000},"page":"1433-1439","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Endoscopic ultrasound\u2010guided drainage using lumen\u2010apposing metal stent of malignant afferent limb syndrome in patients with previous Whipple surgery: Multicenter study (with video)"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8254-7453","authenticated-orcid":false,"given":"Enrique","family":"P\u00e9rez\u2010Cuadrado\u2010Robles","sequence":"first","affiliation":[{"name":"Department of Gastroenterology University of Paris Georges\u2010Pompidou European Hospital Assistance Publique des H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2039-5022","authenticated-orcid":false,"given":"Michiel","family":"Bronswijk","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology University Hospitals Gasthuisberg, University of Leuven  Leuven Belgium"},{"name":"Department of Gastroenterology and Hepatology Imelda General Hospital  Bonheiden Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fr\u00e9deric","family":"Prat","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Hopital Beaujon Assistance Publique des H\u00f4pitaux de Paris  Clichy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Barthet","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy Assistance Publique des H\u00f4pitaux de Marseille  H\u00f4pital Nord, Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Palazzo","sequence":"additional","affiliation":[{"name":"Department of Endoscopy, Hopital Beaujon Assistance Publique des H\u00f4pitaux de Paris  Clichy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Arcidiacono","sequence":"additional","affiliation":[{"name":"Division of Pancreato\u2010Biliary Endoscopy and Endosonography, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Endoscopy and Hepatogastroenterology Regional University Hospital of Nancy  Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Devi\u00e8re","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatopancreatology, and Digestive Oncology Erasme University Hospital \u2013 Universit\u00e9 Libre\u00a0de Bruxelles  Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roy L. J.","family":"van Wanrooij","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology AG&amp;M Research Institute Vrije Universiteit Amsterdam  Amsterdam UMC, Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Tarantino","sequence":"additional","affiliation":[{"name":"Endoscopy Service Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS \u2013 ISMETT)  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0645-1710","authenticated-orcid":false,"given":"Gianfranco","family":"Donatelli","sequence":"additional","affiliation":[{"name":"Department of Surgical, Interventional Endoscopy Unit Private Hospital Peupliers\u2010Ramsay Sant\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marine","family":"Camus","sequence":"additional","affiliation":[{"name":"Sorbonne University, Endoscopic Unit, Saint Antoine Hospital Assistance Publique H\u00f4pitaux de Paris  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andres","family":"Sanchez\u2010Yague","sequence":"additional","affiliation":[{"name":"Endoscopy Unit Hospital Costa del Sol  Marbella Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khanh Do\u2010Cong","family":"Pham","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology, Department of Medicine Haukeland University Hospital  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5772-8236","authenticated-orcid":false,"given":"Jean\u2010Michel","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy Assistance Publique des H\u00f4pitaux de Marseille  H\u00f4pital Nord, Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Anderloni","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Division of Gastroenterology Humanitas Clinical and Research Center \u2013 IRCCS  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Vila","sequence":"additional","affiliation":[{"name":"Endoscopy Unit, Gastroenterology Department Hospital Universitario de Navarra  Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Jezequel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology University Hospital of Brest  Brest France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Larghi","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit Fondazione Policlinico Universitario A. 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