Pérez-Cuadrado-Robles, EnriqueBronswijk, MichielPrat, FrédericBarthet, MarcPalazzo, MaximeArcidiacono, PaoloSchaefer, MarionDevière, Jacquesvan Wanrooij, Roy L JTarantino, IlariaDonatelli, GianfrancoCamus, MarineSanchez-Yague, AndresPham, Khanh Do-CongGonzalez, Jean-MichelAnderloni, AndreaVila, Juan JJezequel, JulienLarghi, AlbertoJaïs, BénédicteVazquez-Sequeiros, EnriqueDeprez, Pierre HVan der Merwe, SchalkCellier, ChristopheRahmi, Gabriel2023-05-032023-05-032022-05-31http://hdl.handle.net/10668/19935Endoscopic ultrasound-guided digestive anastomosis (EUS-A) is a new alternative under evaluation in patients presenting with afferent limb syndrome (ALS) after Whipple surgery. The aim of the present study is to analyze the safety and effectiveness of EUS-A in ALS. This is an observational multicenter study. All patients ≥18 years old with previous Whipple surgery presenting with ALS who underwent an EUS-A using a lumen-apposing metal stent (LAMS) between 2015 and 2021 were included. The primary outcome was clinical success, defined as resolution of the ALS or ALS-related cholangitis. Furthermore, technical success, adverse event rate, and mortality were evaluated. Forty-five patients (mean age: 65.5 ± 10.2 years; 44.4% male) were included. The most common underlying disease was pancreatic cancer (68.9%). EUS-A was performed at a median of 6 weeks after local tumor recurrence. The most common approach used was the direct/freehand technique (66.7%). Technical success was achieved in 95.6%, with no differences between large (≥15 mm) and small LAMS (97.4% vs. 100%, P = 0.664). Clinical success was retained in 91.1% of patients. A complementary treatment by dilation of the stent followed by endoscopic retrograde cholangiopancreatography through the LAMS was performed in three cases (6.7%). There were six recurrent episodes of cholangitis (14.6%) and two procedure-related adverse events (4.4%) after a median follow-up of 4 months. Twenty-six patients (57.8%) died during the follow-up due to disease progression. EUS-A is a safe and effective technique in the treatment of malignant ALS, achieving high clinical success with an acceptable recurrence rate.enLAMSanastomosisendoscopic ultrasoundgastrojejunostomystentAdolescentAgedFemaleHumansMaleMiddle AgedCholangitisDrainageEndosonographyStentsTreatment OutcomeUltrasonography, Interventionalresearch article35429360open access10.1111/den.143301443-1661https://lirias.kuleuven.be/bitstream/20.500.12942/694373/2/Digestive%20Endoscopy%20-%202022%20-%20P%20rez%e2%80%90Cuadrado%e2%80%90Robles%20-%20Endoscopic%20ultrasound%e2%80%90guided%20drainage%20using%20LAMS%20of%20malignant%20afferent.pdf