Biliary metal stents are superior to plastic stents for preoperative biliary decompression in pancreatic cancer

Abstract

BackgroundIt is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression.MethodsThis was a retrospective study of all patients with obstructive jaundice secondary to pancreatic head cancer who underwent their index endoscopic retrograde cholangiopancreatography (ERCP) and all follow-up biliary stent placements at our center before undergoing pancreaticoduodenectomy. Plastic or SEMS were placed at ERCP for biliary decompression. The main outcome measure was to compare the rate of endoscopic reinterventions between the plastic and SEMS cohorts.Results29 patients who underwent pancreaticoduodenectomy had preoperative biliary stent placement (18 plastic, 11 SEMS) at our center. Whereas none of the 11 patients who underwent SEMS placement had stent dysfunction, 7 of 18 (39%) patients with plastic stents required endoscopic reintervention before surgery (P = 0.02). Reinterventions were due to cholangitis (n = 1) or persistent elevation in serum bilirubin levels (n = 6). Two patients with SEMS underwent EUS-guided fine-needle aspiration after ERCP, which yielded a positive diagnosis of cancer in all cases; SEMS did not impair visualization of the tumor mass at EUS. Pancreaticoduodenectomy was undertaken successfully in all 29 patients and the presence of a SEMS did not interfere with biliary anastomosis. On univariate logistic regression, only SEMS placement was associated with less need for endoscopic reintervention (P = 0.02).ConclusionsSEMS are superior to plastic stents for preoperative biliary decompression in pancreatic cancer.Electronic supplementary materialThe online version of this article (doi:10.1007/s00464-010-1552-6) contains supplementary material, which is available to authorized users.

Clinical Efficacy of Endoscopic Pancreatic Drainage for Pain Relief with Malignant Pancreatic Duct Obstruction

“…According to previous studies (Decker et al, 2011;Adams et al, 2012), pancreatic cancer patients who received metal stent biliary drainage had a better patency, and lower incidence of complications than those treated by plastic biliary stent. Therefore, in this study, all patients were treated with metal stent biliary drainage, and the results showed that jaundice was significantly improved a week after the biliary drainage to basically normal total bilirubin levels.…”

Stent placement as a bridge to surgery in malignant biliary obstruction (pancreatic cancer, distal bile duct cancer, and hilar tumors)

“…A retrospective study compared the outcome of 29 patients who underwent PBD with plastic stents (n ¼ 18) or SEMS (n ¼ 11); endoscopic reintervention was required in 39% of the plastic stent group awaiting surgery, but no reintervention was required in the SEMS group. 64 Furthermore, a multicenter randomized controlled trial found that SEMS had an longer patency than plastic stents. 65 This study was performed in palliative patients.…”

Pancreatic Adenocarcinoma

“…Therefore, current recommendations for consideration of preoperative biliary drainage/stent include patients with the following symptoms/complications-cholangitis, severe intractable pruritus, and coagulopathyand those who will not undergo immediate surgical resection [ 32 , 33 ]. Self-expanding metallic stents are preferred over plastic ones [ 36 ].…”