Endoscopic ultrasound-guided antegrade treatment with uncovered self-expanding metal stent for malignant afferent loop syndrome-complicated cholangitis after biliary reconstruction

Malignant afferent loop syndrome often causes cholangitis and jaundice [1] [2], necessitating treatment. Endoscopic treatment is minimally invasive and utilizes a natural orifice, proving advantageous surgical or percutaneous management. Endoscopic ultrasound (EUS)-guided gastrojejunostomy (EUS-GJ) [3] [4] is efficacious; however, severe adverse events are a concern. Therefore, treatment using physiological orifices is desirable. Herein, we report the first case of successful uncovered self-expanding metal stent (USEMS) placement with EUS-guided antegrade treatment using a physiological orifice for malignant afferent loop syndrome after biliary reconstruction for cholangiocarcinoma.