Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(11): E1603-E1610
DOI: 10.1055/a-1244-1989
Original article

Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer

Tsuyoshi Takeda
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Takashi Sasaki
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Takafumi Mie
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Takaaki Furukawa
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Ryo Kanata
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Akiyoshi Kasuga
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Masato Matsuyama
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Masato Ozaka
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
,
Naoki Sasahira
Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims Self-expandable metallic stents (SEMS) are now widely used even for patients with borderline resectable (BR) pancreatic cancer (PC), as neoadjuvant therapy has become common. Therefore, we conducted this study to evaluate safety of SEMS placement in the population including BR PC and to explore risk factors for recurrent biliary obstruction (RBO), pancreatitis, and cholecystitis.

Patients and methods We retrospectively investigated consecutive patients with PC who received initial SEMS between January 2015 and March 2019. We compared time to RBO (TRBO), causes of RBO, and stent-related adverse events (AEs) according to resectability status. Univariate and multivariate analyses were performed to explore risk factors for TRBO, pancreatitis, and cholecystitis.

Results A total of 135 patients were included (BR 31 and unresectable [UR] 104). Stent-related AEs occurred in 39 patients: pancreatitis 14 (mild/moderate/severe 1/6/7), cholecystitis 12, and non-occluding cholangitis 13. TRBO, causes of RBO, and stent-related AEs were not significantly different according to resectability status. Overall rate of RBO was higher in UR PC due to the longer follow-up period. Sharp common bile duct (CBD) angulation was an independent risk factor for short duration of TRBO. High pancreatic volume index and SEMS of high axial force were independent risk factors for pancreatitis, whereas tumor involvement to orifice of cystic duct was the only risk factor for cholecystitis.

Conclusions We demonstrated that SEMS can be safely deployed even in patients with BR PC. Sharp CBD angulation and high pancreatic volume index were identified as novel risk factors for RBO and pancreatitis, respectively, after SEMS placement.



Publication History

Received: 28 April 2020

Accepted: 03 August 2020

Article published online:
22 October 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Siegel RL, Miller KD, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin 2017; 67: 7-30
    CrossrefPubMedGoogle Scholar
  • 2 Lucas AL, Malvezzi M, Carioli G. et al. Global Trends in pancreatic cancer mortality from 1980 through 2013 and predictions for 2017. Clin Gastroenterol Hepatol 2016; 14: 1452-1462.e1454
    CrossrefPubMedGoogle Scholar
  • 3 Sasaki T, Kanata R, Yamada I. et al. Improvement of treatment outcomes for metastatic pancreatic cancer: a real-world data analysis. In Vivo 2019; 33: 271-276
    CrossrefPubMedGoogle Scholar
  • 4 Schnelldorfer T, Ware AL, Sarr MG. et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible?. Ann Surg 2008; 247: 456-462
    CrossrefPubMedGoogle Scholar
  • 5 Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 2015; 220: 530-536
    CrossrefPubMedGoogle Scholar
  • 6 Versteijne E, Vogel JA, Besselink MG. et al. Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg 2018; 105: 946-958
    CrossrefPubMedGoogle Scholar
  • 7 Shubert CR, Bergquist JR, Groeschl RT. et al. Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: An intention to treat analysis of the National Cancer Database. Surgery 2016; 160: 1080-1096
    CrossrefPubMedGoogle Scholar
  • 8 Dhir M, Malhotra GK, Sohal DPS. et al. Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients. World J Surg Oncol 2017; 15: 183
    CrossrefPubMedGoogle Scholar
  • 9 Barenboim A, Lahat G, Geva R. et al. Neoadjuvant FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer: An intention to treat analysis. Eur J Surg Oncol 2018; 44: 1619-1623
    CrossrefPubMedGoogle Scholar
  • 10 Ielpo B, Duran H, Diaz E. et al. Preoperative treatment with gemcitabine plus nab-paclitaxel is a safe and effective chemotherapy for pancreatic adenocarcinoma. Eur J Surg Oncol 2016; 42: 1394-1400
    CrossrefPubMedGoogle Scholar
  • 11 Chawla A, Ferrone CR. Neoadjuvant therapy for resectable pancreatic cancer: an evolving paradigm shift. Frontiers Oncol 2019; 9: 1085
    CrossrefPubMedGoogle Scholar
  • 12 Motoi F, Kosuge T, Ueno H. et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol 2019; 49: 190-194
    CrossrefPubMedGoogle Scholar
  • 13 Isayama H, Yasuda I, Ryozawa S. et al. Results of a Japanese multicenter, randomized trial of endoscopic stenting for non-resectable pancreatic head cancer (JM-test): Covered Wallstent versus DoubleLayer stent. Dig Endosc 2011; 23: 310-315
    CrossrefPubMedGoogle Scholar
  • 14 Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 2017; 112: 260-273
    CrossrefPubMedGoogle Scholar
  • 15 Kubota K, Sato T, Watanabe S. et al. Covered self-expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer. Dig Endosc 2014; 26: 77-86
    CrossrefPubMedGoogle Scholar
  • 16 Gardner TB, Spangler CC, Byanova KL. et al. Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial. Gastrointest Endosc 2016; 84: 460-466
    CrossrefPubMedGoogle Scholar
  • 17 Siddiqui AA, Mehendiratta V, Loren D. et al. Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: outcomes in 241 patients. Dig Dis Sci 2013; 58: 1744-1750
    CrossrefPubMedGoogle Scholar
  • 18 Tsuboi T, Sasaki T, Serikawa M. et al. Preoperative biliary drainage in cases of borderline resectable pancreatic cancer treated with neoadjuvant chemotherapy and surgery. Gastroenterol Res Pract 2016; 2016: 7968201
    CrossrefPubMedGoogle Scholar
  • 19 Wasan SM, Ross WA, Staerkel GA. et al. Use of expandable metallic biliary stents in resectable pancreatic cancer. Am J Gastroenterol 2005; 100: 2056-2061
    CrossrefPubMedGoogle Scholar
  • 20 Tol JA, van Hooft JE, Timmer R. et al. Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut 2016; 65: 1981-1987
    CrossrefPubMedGoogle Scholar
  • 21 Tempero MA, Malafa MP, Al-Hawary M. et al. Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2017; 15: 1028-1061
    CrossrefPubMedGoogle Scholar
  • 22 Kim KY, Han J, Kim HG. et al. Late Complications and stone recurrence rates after bile duct stone removal by endoscopic sphincterotomy and large balloon dilation are similar to those after endoscopic sphincterotomy alone. Clin Endosc 2013; 46: 637-642
    CrossrefPubMedGoogle Scholar
  • 23 Isayama H, Hamada T, Yasuda I. et al. TOKYO criteria 2014 for transpapillary biliary stenting. Dig Endosc 2015; 27: 259-264
    CrossrefPubMedGoogle Scholar
  • 24 Cotton PB, Eisen GM, Aabakken L. et al. A lexicon for endoscopic adverse events: report of an ASGE workshop. Gastrointest Endosc 2010; 71: 446-454
    CrossrefPubMedGoogle Scholar
  • 25 Kanda Y. Investigation of the freely available easy-to-use software 'EZR' for medical statistics. Bone Marrow Transplant 2013; 48: 452-458
    CrossrefPubMedGoogle Scholar
  • 26 Miura S, Kanno A, Masamune A. et al. Risk factors for recurrent biliary obstruction following placement of self-expandable metallic stents in patients with malignant perihilar biliary stricture. Endoscopy 2016; 48: 536-545
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Keizman D, Shalom MI, Konikoff FM. An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction. Surg Endosc 2006; 20: 1594-1599
    CrossrefPubMedGoogle Scholar
  • 28 Yoo ES, Yoo BM, Kim JH. et al. Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy. Scand J Gastroenterol 2018; 53: 466-470
    CrossrefPubMedGoogle Scholar
  • 29 Shimizu S, Naitoh I, Nakazawa T. et al. Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction. J Gastroenterol Hepatol 2013; 28: 68-72
    CrossrefPubMedGoogle Scholar
  • 30 Kawakubo K, Isayama H, Nakai Y. et al. Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc 2012; 26: 771-776
    CrossrefPubMedGoogle Scholar
  • 31 Cote GA, Kumar N, Ansstas M. et al. Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents. Gastrointest Endosc 2010; 72: 748-754
    CrossrefPubMedGoogle Scholar
  • 32 Maruyama H, Shiba M, Ishikawa-Kakiya Y. et al. Positive correlation between pancreatic volume and post-endoscopic retrograde cholangiopancreatography pancreatitis. J Gastroenterol Hepatol 2019; DOI: 10.1111/jgh.14878.
    CrossrefPubMedGoogle Scholar
  • 33 Nakai Y, Isayama H, Kawakubo K. et al. Metallic stent with high axial force as a risk factor for cholecystitis in distal malignant biliary obstruction. J Gastroenterol Hepatol 2014; 29: 1557-1562
    CrossrefPubMedGoogle Scholar
  • 34 Suk KT, Kim HS, Kim JW. et al. Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction. Gastrointest Endosc 2006; 64: 522-529
    CrossrefPubMedGoogle Scholar
  • 35 Isayama H, Kawabe T, Nakai Y. et al. Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 2006; 4: 1148-1153
    CrossrefPubMedGoogle Scholar