Combined endoscopic drainage for afferent loop obstruction and bilioenteric anastomosis stricture in a patient after pancreatoduodenectomy

Tumor recurrence is a common cause of bilioenteric anastomosis stricture or afferent loop obstruction (ALO) in patients who have undergone pancreaticoduodenectomy. Endoscopic management in ALO included enteroscopy-assisted luminal stenting with a self-expanding metal stent or plastic stents and endoscopic ultrasound (EUS)-guided enteroenterostomy with a lumen-apposing metal stent [1] [2]. In addition, the bridge technique for drainage of the right liver across the left liver through hepaticogastrostomy (HGS) is feasible [3] [4]. We describe a case of concurrent ALO and bilioenteric anastomosis stricture in a patient who received the above two endoscopic treatments.