CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(06): E714-E721
DOI: 10.1055/a-0599-6190
Original article
Owner and Copyright © Georg Thieme Verlag KG 2018

Safety and efficacy of self-expanding metal stents for biliary drainage in patients receiving neoadjuvant therapy for pancreatic cancer

Darren D. Ballard
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
,
Syed Rahman
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
,
Brian Ginnebaugh
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
,
Abdul Khan
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
,
Kulwinder S. Dua
Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI, U.S.A.
› Author Affiliations
Further Information

Publication History

submitted 08 November 2017

accepted after revision 20 February 2018

Publication Date:
25 May 2018 (online)

Abstract

Background and study aims Durable biliary drainage is essential during neoadjuvant therapy (NAT) in patients with pancreatic cancer who present with biliary obstruction. Plastic stents (PS) tend to occlude readily, resulting in delay/interruption of treatment. Our aim was to evaluate the safety and efficacy of self-expanding metal stents (SEMS) for biliary drainage in patients receiving NAT for pancreatic cancer.

Patients and methods From 2009 to 2014, all consecutive patients with resectable pancreatic cancer at one tertiary center had SEMS placed for biliary drainage before NAT was started. Data on biliary drainage efficacy, stent malfunction rates and procedural adverse events were collected.

Results One hundred forty-two consecutive patients with pancreatic cancer (mean age 66 ± 9 SD years; 81 male, 61 female; 67 resectable, 75 borderline resectable) were enrolled. Eight-seven patients (61 %) had prior PS exchanged to SEMS and 55 (39 %) had SEMS placed upfront. Median duration from SEMS placement to the end of NAT/surgery was 111 days (range 44 – 282). During NAT, SEMS malfunction requiring reintervention occurred in 16 patients (11.2 %): tissue ingrowth 11, stent occlusion from food 6, stent migration 3, incomplete expansion 1, “tissue cheese-cutter” effect 1, and cystic duct obstruction 1. On subgroup analysis, no correlation between SEMS malfunction and stage of disease, prior PS, or duration of NAT was found (r2 = 0.05, P = 0.34). Presence of SEMS in situ did not affect pancreaticoduodenectomy.

Conclusion SEMS provide safe, effective and durable biliary drainage during NAT for pancreas cancer. Previously placed PS can be exchanged for SEMS. SEMS do not require removal prior to surgery.

Meeting presentations: Digestive Disease Week 2015 and 2017