Case Report: Endoscopic geometric remodeling for angulation-type efferent loop stenosis after pancreaticoduodenectomy

Efferent loop stenosis is a rare complication after pancreaticoduodenectomy with Child reconstruction. A 51-year-old woman with a pancreatic tumor underwent laparoscopic pancreaticoduodenectomy and developed impaired gastric emptying on postoperative day 7 with high bilious drainage (800–1,100 mL daily). Conservative treatment for five days did not improve symptoms. Endoscopy revealed a sharply angulated gastrojejunal anastomosis without a discrete stricture ring. Physicians used a combined approach: endoscopic submucosal dissection to partially remove a mucosal ridge, clips for hemostasis and traction, and temporary placement of a self-expanding metal stent. After the procedure, the patient's condition improved and oral intake was gradually resumed. At one month, the anastomosis showed no stenosis, and at three months, the patient reported good appetite and a weight gain of approximately 5 kg.