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Afferent loop syndrome

MedGen UID:
161
•Concept ID:
C0001727
•
Disease or Syndrome
Synonyms: Afferent Loop Syndrome; Afferent Loop Syndromes; Loop Syndrome, Afferent; Loop Syndromes, Afferent; Syndrome, Afferent Loop; Syndromes, Afferent Loop
SNOMED CT: Afferent loop syndrome (20813000)
 
Monarch Initiative: MONDO:0006641

Definition

A complication of gastrojejunostomy (billroth II procedure), a reconstructive gastroenterostomy. It is caused by acute (complete) or chronic (intermittent) obstruction of the afferent jejunal loop due to hernia, intussusception, kinking, volvulus, etc. It is characterized by pain and vomiting of bile-stained fluid. [from MONDO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVAfferent loop syndrome

Professional guidelines

PubMed

Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.
van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, Hucl T, Kunda R, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, Perez-Miranda M, van Hooft JE
Endoscopy 2022 Feb;54(2):185-205. Epub 2021 Dec 22 doi: 10.1055/a-1717-1391. PMID: 34937098
Diagnosis and treatment of the afferent loop syndrome.
Termsinsuk P, Chantarojanasiri T, Pausawasdi N
Clin J Gastroenterol 2020 Oct;13(5):660-668. Epub 2020 Jul 8 doi: 10.1007/s12328-020-01170-z. PMID: 32638230
Endoscopic ultrasound-guided management of malignant afferent loop syndrome after gastric bypass: from diagnosis to therapy.
Monino L, Barthet M, Gonzalez JM
Endoscopy 2020 Mar;52(3):E84-E85. Epub 2019 Jul 1 doi: 10.1055/a-0948-5033. PMID: 31261429

Recent clinical studies

Etiology

Malnutrition Following One-Anastomosis Gastric Bypass: a Systematic Review.
Bandlamudi N, Holt G, Graham Y, O'Kane M, Singhal R, Parmar C, Sakran N, Mahawar K, Pouwels S, Potluri S, Madhok B
Obes Surg 2023 Dec;33(12):4137-4146. Epub 2023 Nov 2 doi: 10.1007/s11695-023-06907-6. PMID: 37917389
Endoscopic ultrasound-guided gastrointestinal anastomosis: Current status and future perspectives.
Bronswijk M, Pérez-Cuadrado-Robles E, Van der Merwe S
Dig Endosc 2023 Jan;35(2):255-263. Epub 2022 Aug 5 doi: 10.1111/den.14381. PMID: 35726383
Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline.
van der Merwe SW, van Wanrooij RLJ, Bronswijk M, Everett S, Lakhtakia S, Rimbas M, Hucl T, Kunda R, Badaoui A, Law R, Arcidiacono PG, Larghi A, Giovannini M, Khashab MA, Binmoeller KF, Barthet M, Perez-Miranda M, van Hooft JE
Endoscopy 2022 Feb;54(2):185-205. Epub 2021 Dec 22 doi: 10.1055/a-1717-1391. PMID: 34937098
Postgastrectomy Syndromes and Nutritional Considerations Following Gastric Surgery.
Davis JL, Ripley RT
Surg Clin North Am 2017 Apr;97(2):277-293. doi: 10.1016/j.suc.2016.11.005. PMID: 28325187
Enterolithiasis.
Gurvits GE, Lan G
World J Gastroenterol 2014 Dec 21;20(47):17819-29. doi: 10.3748/wjg.v20.i47.17819. PMID: 25548480Free PMC Article

Diagnosis

Diagnosis and treatment of the afferent loop syndrome.
Termsinsuk P, Chantarojanasiri T, Pausawasdi N
Clin J Gastroenterol 2020 Oct;13(5):660-668. Epub 2020 Jul 8 doi: 10.1007/s12328-020-01170-z. PMID: 32638230
Enterolithiasis.
Gurvits GE, Lan G
World J Gastroenterol 2014 Dec 21;20(47):17819-29. doi: 10.3748/wjg.v20.i47.17819. PMID: 25548480Free PMC Article
Diagnosis and management of afferent limb syndrome in patients with ileal pouch-anal anastomosis.
Kirat HT, Kiran RP, Remzi FH, Fazio VW, Shen B
Inflamm Bowel Dis 2011 Jun;17(6):1287-90. Epub 2010 Oct 26 doi: 10.1002/ibd.21503. PMID: 21560192
Postgastrectomy syndromes.
Brooke-Cowden GL, Braasch JW, Gibb SP, Haggitt RC, McDermott WV
Am J Surg 1976 Apr;131(4):464-70. doi: 10.1016/0002-9610(76)90158-6. PMID: 1267099
The afferent loop syndrome.
Bushkin FL, Woodward ER
Major Probl Clin Surg 1976;20:34-48. PMID: 957782

Therapy

Endoscopic ultrasound-guided gastrointestinal anastomosis: Current status and future perspectives.
Bronswijk M, Pérez-Cuadrado-Robles E, Van der Merwe S
Dig Endosc 2023 Jan;35(2):255-263. Epub 2022 Aug 5 doi: 10.1111/den.14381. PMID: 35726383
Gastrointestinal: afferent loop syndrome.
Herbella F, Lee TC, Matone J, Del Grande J, Liu KL, Tsai MC, Lin MT, Wang HP
J Gastroenterol Hepatol 2006 Aug;21(8):1346. doi: 10.1111/j.1440-1746.2006.04601.x. PMID: 16872321
Postgastrectomy syndromes.
Eagon JC, Miedema BW, Kelly KA
Surg Clin North Am 1992 Apr;72(2):445-65. doi: 10.1016/s0039-6109(16)45689-6. PMID: 1549803
Postgastrectomy syndromes.
Brooke-Cowden GL, Braasch JW, Gibb SP, Haggitt RC, McDermott WV
Am J Surg 1976 Apr;131(4):464-70. doi: 10.1016/0002-9610(76)90158-6. PMID: 1267099
Afferent loop syndrome.
McInre JA, Cheng PZ
Can J Surg 1969 Oct;12(4):389-96. PMID: 5352672

Prognosis

Severe acute pancreatitis in the early postoperative period due to afferent loop syndrome following gastrectomy for gastric cancer.
Kandhala S, Kumar N, Goswami AG, Rai A, Mallik D, Chauhan U, Basu S
Ann R Coll Surg Engl 2022 Nov;104(9):e252-e254. Epub 2022 Apr 21 doi: 10.1308/rcsann.2022.0009. PMID: 35446709Free PMC Article
Enterolithiasis.
Gurvits GE, Lan G
World J Gastroenterol 2014 Dec 21;20(47):17819-29. doi: 10.3748/wjg.v20.i47.17819. PMID: 25548480Free PMC Article
Afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction.
Aoki M, Saka M, Morita S, Fukagawa T, Katai H
World J Surg 2010 Oct;34(10):2389-92. doi: 10.1007/s00268-010-0602-5. PMID: 20458583
Postgastrectomy syndromes.
Eagon JC, Miedema BW, Kelly KA
Surg Clin North Am 1992 Apr;72(2):445-65. doi: 10.1016/s0039-6109(16)45689-6. PMID: 1549803
The afferent loop syndrome.
Bushkin FL, Woodward ER
Major Probl Clin Surg 1976;20:34-48. PMID: 957782

Clinical prediction guides

Efficacy of endoscopic ultrasound-guided gastroenterostomy using self-expandable metallic stent for afferent loop syndrome: A single-center retrospective study.
Hagiwara Y, Hijioka S, Nagashio Y, Maruki Y, Ohba A, Kawasaki Y, Takeshita K, Takasaki T, Agarie D, Hara H, Yagi S, Fukuda S, Kuwada M, Yamashige D, Okamoto K, Chatto M, Kondo S, Morizane C, Ueno H, Endo M, Sugawara S, Sone M, Saito Y, Tsuchiya K, Okusaka T
J Gastroenterol Hepatol 2024 Oct;39(10):2136-2142. Epub 2024 Jun 7 doi: 10.1111/jgh.16649. PMID: 38845460
Endoscopic management of afferent loop syndrome caused by enteroliths and anastomotic stricture. A case report.
Alves AR, Almeida N, Ferreira M, Tomé L
Rev Esp Enferm Dig 2017 Jun;109(6):457. PMID: 28597677
Enterolithiasis.
Gurvits GE, Lan G
World J Gastroenterol 2014 Dec 21;20(47):17819-29. doi: 10.3748/wjg.v20.i47.17819. PMID: 25548480Free PMC Article
Using multidetector-row CT for the diagnosis of afferent loop syndrome following gastroenterostomy reconstruction.
Juan YH, Yu CY, Hsu HH, Huang GS, Chan DC, Liu CH, Tung HJ, Chang WC
Yonsei Med J 2011 Jul;52(4):574-80. doi: 10.3349/ymj.2011.52.4.574. PMID: 21623598Free PMC Article
The afferent loop syndrome.
Bushkin FL, Woodward ER
Major Probl Clin Surg 1976;20:34-48. PMID: 957782

Recent systematic reviews

Malnutrition Following One-Anastomosis Gastric Bypass: a Systematic Review.
Bandlamudi N, Holt G, Graham Y, O'Kane M, Singhal R, Parmar C, Sakran N, Mahawar K, Pouwels S, Potluri S, Madhok B
Obes Surg 2023 Dec;33(12):4137-4146. Epub 2023 Nov 2 doi: 10.1007/s11695-023-06907-6. PMID: 37917389

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