Endoscopic Management of Efferent Loop Syndrome and Its Complications: Lessons Learnt

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Both afferent and efferent loop syndromes are rare complications that can develop post-gastro-jejunostomy. Although the incidence of afferent loop syndrome is ~0.3% to 1%, efferent loop syndrome is extremely rare with only limited case reports. We report a case of malignant efferent loop obstruction which was successfully managed by an endoscopic luminal self-expanding metal stent. This led to an unusual complication of obstructive jaundice with cholangitis secondary to a mechanical afferent loop syndrome requiring an additional endoscopic luminal stenting of the afferent loop. Endoscopic management of afferent or efferent loop syndromes is technically challenging and a consecutive occurrence of the dual-loop syndromes should be expected by the interventional endoscopist.