Case Report: Endoscopic geometric remodeling for angulation-type efferent loop stenosis after pancreaticoduodenectomy
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By
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Donghai Wu
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Shihua Ding
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Na Li
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Weitao Wu
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Jingbo Yang
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Jiahuang Huang
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June 18, 2026
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Clinical Scorecard: Endoscopic Geometric Reshaping for Angulation-Induced Efferent Loop Stenosis Following Pancreaticoduodenectomy: A Case Study
At a Glance
| Category | Detail |
|---|
| Condition | |
| Key Mechanisms | Fixed angulation of the efferent loop causing delayed gastric emptying, emphasizing the distinction from concentric narrowing. |
| Target Population | |
| Care Setting | |
Key Highlights
- Efferent loop stenosis is a rare cause of delayed gastric emptying post-PD, particularly due to angulation.
- Conventional endoscopic dilation may be unsafe in cases of fixed angulation, necessitating alternative approaches.
- Endoscopic submucosal dissection (ESD) combined with stenting was used effectively to address the issue.
- The patient showed significant improvement post-procedure, with a return to normal function.
- This approach may serve as a viable alternative to surgical revision in selected cases.
Guideline-Based Recommendations
Diagnosis
- Imaging studies such as CT or MRI to assess for ELS and delayed gastric emptying.
Management
Monitoring & Follow-up
Risks
Patient & Prescribing Data
Combined endoscopic techniques, including ESD and stenting, can effectively address angulation-type ELS.
Clinical Best Practices
- Consider ESD for mucosal release in cases of angulation-induced ELS, based on successful outcomes.
- Utilize temporary stenting to maintain efferent loop patency, as demonstrated in the case.
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