Original article
Clinical endoscopy
Efficacy and safety of self-expandable metal stents for biliary decompression in patients receiving neoadjuvant therapy for pancreatic cancer: a prospective study

Presented at Digestive Disease Week, May 5-8, 2011, Chicago, Illinois.
https://doi.org/10.1016/j.gie.2012.02.041Get rights and content

Background

Increasing numbers of patients with resectable pancreatic cancer are receiving neoadjuvant therapy. Biliary drainage with plastic stents during this period can be associated with recurrent episodes of stent occlusion resulting in unplanned ERCPs and interruptions in therapy.

Objective

To evaluate the efficacy and safety of self-expandable metal stents (SEMSs) during the neoadjuvant period for resectable pancreatic cancer.

Design

Patients with proven pancreatic adenocarcinoma with biliary obstruction underwent placement of SEMSs, and data on stent patency and complication rates were collected prospectively.

Setting

Tertiary-care referral center.

Patients

This study involved 55 patients with resectable and borderline resectable pancreatic duct adenocarcinoma who were recruited between March 2009 and December 2010.

Intervention

SEMSs were placed for biliary decompression. The shortest length of stent required to bridge the stricture was used so as to leave enough of the normal bile duct above the stent available for subsequent surgical anastomosis. Endoscopic reintervention was performed in those with stent malfunction. Stents were not removed before surgery.

Main Outcome Measurements

Stent patency rate during the neoadjuvant period, stent malfunction rate, and complication rates. Information on stent-related difficulties, if any, during surgery.

Results

Fifty-five patients were recruited (29 men, 26 women; age, mean [± SD] 65.9 ± 11 years; resectable 23, borderline resectable 32). Median time for neoadjuvant therapy and restaging before surgery was 104 days (range 70-260 days). At the median time of 104 days, 88% of SEMSs remained patent. By 260 days, stent malfunction occurred in 15% of patients. These included stent occlusion in 13% and stent migration in 2%. SEMS malfunction occurred in 3 of 27 patients (11%) who ultimately underwent pancreaticoduodenectomy and in 5 of 21 patients (24%) with disease progression (P = not significant). The presence of SEMSs did not interfere with pancreaticoduodenectomy in any patients who underwent surgery.

Limitations

Nonrandomized study.

Conclusion

SEMSs are effective and safe in achieving durable biliary drainage in patients with pancreatic cancer receiving neoadjuvant therapy. It is not necessary to remove SEMSs before surgery if the shortest length of stent required to bridge the stricture is used.

Section snippets

Patients and methods

This study was conducted at one tertiary-care medical center where all patients with resectable or potentially resectable pancreatic cancer receive neoadjuvant therapy and are managed with a multidisciplinary approach. All patients provided written informed consent for endoscopic and surgical procedures as well as neoadjuvant therapy. The study was approved by the Medical College of Wisconsin institutional review board.

From March 2009 to December 2010, all patients with proven pancreatic

Results

Over a 22-month period, a total of 55 consecutive patients (29 men, 26 women; mean [± SD] age 65.9 ± 11 years) with pancreatic cancer and biliary obstruction had SEMSs placed to relieve biliary occlusion, and all of these patients underwent neoadjuvant therapy. Of the 55 patients, 33 (60%) had undergone ERCP at an outside hospital and presented with a plastic stent in place (Table 2). The majority of these plastic stents (90%) were 10F in diameter. The median duration for which the plastic

Discussion

In 2012, it is estimated that 43,920 new cases of pancreatic cancer will be diagnosed in the United States, and 37,390 will die from the disease.17 Surgical resection is the only chance for cure. Obstructive jaundice develops in up to 77% of patients with cancer of the head of the pancreas.18 However, because spontaneous cholangitis is rare with malignant biliary obstruction (unless the bile duct is contaminated with interventions), biliary drainage may not be necessary in those going for early

References (24)

  • F.R. Spitz et al.

    Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas

    J Clin Oncol

    (1997)
  • P.W. Pisters et al.

    Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma

    J Clin Oncol

    (1998)
  • Cited by (0)

    If you would like to chat with an author of this article, you may contact Dr Dua at [email protected].

    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

    See CME section; p. 159.

    View full text