LAUSR

Malignant afferent limb syndrome (ALS) is a rare adverse event that can occur after pancreaticoduodenectomy. Patients can be seen with a range of clinical conditions, including obstructive jaundice, cholangitis, nonbilious vomiting, and acute abdominal pain. Patients with malignant ALS are often poor surgical candidates. Endoscopic decompression provides a safe and effective alternative to surgical bypass. Here, we report a unique case of malignant ALS, in which we used a pre-existing internal/external biliary drain to assist in creating an EUSguided gastroenterostomy.