BMJ Case Reports 2018; doi:10.1136/bcr-2018-227167
  • Images in…

Successful endoscopic management of efferent loop syndrome after Billroth II distal gastrectomy

  1. Prashant Sinha
  1. Department of Surgery, NYU Langone Hospital - Brooklyn, Brooklyn, New York, USA
  1. Correspondence to Dr Kevin Bain, kevin.bain{at}
  • Accepted 16 October 2018
  • Published 5 November 2018


We present the case of a 60-year-old woman with gastric adenocarcinoma presenting for elective surgical resection. The patient underwent an uncomplicated distal gastrectomy with Billroth II reconstruction, and D2 lymphadenectomy.

On postoperative day 3, an upper gastrointestinal series showed interval progression of oral contrast into the colon. The patient was subsequently started on a liquid diet.

On postoperative days 4–6, the patient was unable to tolerate sufficient oral intake. A repeat upper gastrointestinal series was obtained (figure 1), with findings of obstruction of the efferent limb. The patient was taken for oesophagogastroduodenoscopy which demonstrated a stenosed Billroth II gastrojejunal anastomosis at the efferent limb site. The anastomosis was transversed, and a 2.3x10.5 cm WallFlex covered stent was placed under fluoroscopic guidance (figure 2).

Figure 1

Upper gastrointestinal series with findings suspicious for obstruction of the efferent limb. (A) Passage of contrast through the gastrojejunal anastomosis. (B) However, essentially all contrast flows retrograde into the afferent limb, (C,D) with backflow into the stomach. No passage of contrast into the efferent limb.

Figure 2

Endoscopic findings of the gastrojejunal …

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