BACKGROUND Malignant afferent loop obstruction (mALO) can cause cholangitis, pancreatitis, and perforation due to blind loop dilatation. However, peritoneal dissemination, lymph node metastasis, and recurrence of the tumor are the main causes of mALO, and most cases are in the advanced stage with thoracicoabdominal fluid retention, for which surgery and percutaneous transhepatic treatment are challenging. At our hospital, endoscopic metal stent placement (EMSP) has been applied for such mALO. We retrospectively investigated the usefulness of EMSP for mALO. METHODS We conducted a retrospective analysis of 11 mALO patients with EMSP between January 2008 and December 2018. The following items were evaluated: the characteristics of patients, technical success and adverse events of EMSP, clinical efficacy, and outcome after EMSP. RESULTS The surgical procedures and reconstruction methods were distal gastrectomy with Billroth II reconstruction for 3 patients, pancreaticoduodenectomy with modified-Child reconstruction for 7, choledochojejunostomy with Roux-en-Y reconstruction for 1. The cause of mALO was peritoneal dissemination for 6 patients, local recurrence for 3, lymph node metastasis for 1, and afferent loop invasion for 1. EMSP was attempted in 13 sessions for 11 patients, and successful in 12 of 13 sessions. There were no adverse events. The clinical efficacy was high in successful EMSP. The median survival time after EMSP was 118 days. Ten patients died of primary disease and one patient died of uncontrollable cholangitis after the failure of EMSP. mALO recurred and EMSP was repeated for 2 of 10 patients who died of primary disease. CONCLUSIONS The success rate of EMSP for mALO was high in patients with poor general conditions due to advanced-stage malignant tumors and it was able to be safely performed, suggesting its high clinical efficacy. The incidence of mALO recurrence after EMSP was low.

中文翻译：

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内镜金属支架置入对恶性传入环阻塞的有用性。

背景技术恶性传入环阻塞（mALO）可能由于盲环扩张而引起胆管炎，胰腺炎和穿孔。然而，腹膜播散，淋巴结转移和肿瘤复发是mALO的主要原因，大多数病例处于胸腹水retention留的晚期，因此手术和经皮肝穿刺治疗具有挑战性。在我们医院，内镜金属支架置入术（EMSP）已用于此类mALO。我们回顾性研究了EMSP对mALO的有用性。方法我们对2008年1月至2018年12月间11例mALO EMSP患者进行了回顾性分析。评估了以下项目：患者的特征，EMSP的技术成功和不良事件，EMSP的临床疗效以及结局。结果手术方法和重建方法为远端胃切除术和Billroth II重建术3例，胰十二指肠切除术联合改良儿童重建术7例，胆总管空肠吻合术与Roux-en-Y重建术1例。mALO的病因是腹膜扩散6例，局部复发3例，淋巴结转移1例，传入环浸润1例。11例患者尝试了13疗程的EMSP，13疗程中的12疗程成功。没有不良事件。成功的EMSP的临床疗效很高。EMSP后的中位生存时间为118天。EMSP失败后，有10例患者死于原发性疾病，1例患者死于无法控制的胆管炎。死于原发性疾病的10名患者中有2名复发了mALO，并重复了EMSP。结论由于晚期恶性肿瘤，在一般情况较差的患者中，EMSP对mALO的成功率很高，并且能够安全进行，表明其具有很高的临床疗效。EMSP后mALO复发的发生率较低。