Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience

Pannala, Rahul; Brandabur, John J.; Gan, Seng-Ian; Gluck, Michael; Irani, Shayan; Patterson, David J.; Ross, Andrew S.; Dorer, Russell; Traverso, L. William; Picozzi, Vincent J.; Kozarek, Richard A.

doi:10.1016/j.gie.2011.04.029

« Previous Next »Gastrointestinal Endoscopy
Volume 74, Issue 2 , Pages 295-302, August 2011

Afferent limb syndrome and delayed GI problems after pancreaticoduodenectomy for pancreatic cancer: single-center, 14-year experience

Rahul Pannala, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
John J. Brandabur, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Seng-Ian Gan, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Michael Gluck, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Shayan Irani, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
David J. Patterson, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Andrew S. Ross, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
Russell Dorer, MD
- Department of Pathology, Virginia Mason Medical Center, Seattle, Washington, USA
L. William Traverso, MD
- Department of Surgery, Virginia Mason Medical Center, Seattle, Washington, USA
Vincent J. Picozzi, MD
- Department of Hematology and Oncology, Virginia Mason Medical Center, Seattle, Washington, USA
Richard A. Kozarek, MD
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, USA
- Reprint requests: Richard A. Kozarek, MD, Virginia Mason Medical Center, 1100 9th Avenue, Seattle, WA 98101

Received 6 December 2010; accepted 19 April 2011. published online 20 June 2011.

Background

There are limited data on the incidence of afferent limb syndrome and other delayed GI problems in pancreatic cancer (PaC) patients, especially among long-term survivors (>2 years).

Objective

To evaluate the incidence of afferent limb syndrome (chronic afferent limb obstruction resulting in pancreatobiliary obstruction) and delayed GI problems in PaC patients after pancreaticoduodenectomy (PD).

Design

Retrospective case series.

Setting

Tertiary referral center.

Patients

PaC patients treated with PD (N = 186) over a 14-year period (January 1995-October 2009).

Interventions

Endoscopic balloon dilation and stent placement, percutaneous biliary drainage.

Main Outcome Measurements

Incidence of afferent limb syndrome and delayed GI complications (marginal ulcers, radiation enteropathy, anastomotic strictures).

Results

Mean age was 63 ± 10 years; 55% of patients were male. Afferent limb syndrome was noted in 24 patients (13%). Median time to diagnosis was 1.2 years (range 0.03-12.3 years); obstruction was primarily caused by recurrent PaC (8 patients, 33%) and radiation enteropathy (9 patients, 38%). Afferent limb syndrome was more likely to develop in patients with 2 years or longer of follow-up (n = 71, [38%]) compared with patients with 2 years or less of follow-up, after controlling for age, sex, surgery type, and adjuvant treatment (adjusted odds ratio, 4.5; 95% CI, 1.8-11.7). Other delayed GI problems included radiation enteropathy (6%), marginal ulcers (5%), anastomotic strictures (4%), cholangitis/liver abscesses (5%), and GI bleeding (6%).

Limitations

Retrospective, single-center study.

Conclusions

GI problems, including afferent limb syndrome, are relatively common in PaC patients after surgery and adjuvant therapy. Clinicians should recognize and effectively treat these delayed GI problems, especially in long-term survivors.

Abbreviations: PaC, pancreatic cancer, PD, pancreaticoduodenectomy, PTBD, percutaneous transhepatic biliary drainage