Asian EUS Cup-08: Endoscopic ultrasound-guided drainage of afferent loop obstruction due to recurrent gastric carcinoma

A 60-year-old woman presented with a history of T4N3b carcinoma of stomach with subtotal gastrectomy and roux-en-Y reconstruction performed. Adjuvant chemoradiation was given. She developed intestinal obstruction 1 year later with palliative colectomy performed. This time, she presented with repeated vomiting and abdominal pain with urgent computed tomography (CT) showing diffuse small bowel, biliary duct, and pancreatic duct with suspected recurrence at anastomosis. Esophagogastroduodenoscopy with stenting to efferent limb was performed. Subsequently, there was progressive worsening of liver function test. Repeated CT scan showed grossly dilated afferent limb, biliary duct, and pancreatic duct. Endoscopic ultrasound-guided drainage of the afferent limb was performed with lumen apposing metal stent. Liver function test almost normalized after the procedure and the patient was discharged afterward.