Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review

Liu, Pan; Lin, Huapeng; Chen, Yuanyuan; Wu, Yushen; Tang, Ming‐Chun; Liu, Changan

doi:10.1089/lap.2018.0029

Cited by 21 publications

(26 citation statements)

References 28 publications

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“…Furthermore, if preoperative drainage is required, the use of a SEMS is favored over a plastic stent, based on the results of two meta-analyses. These concluded that SEMSs were associated with lower rates of endoscopic re-intervention and perioperative cholangitis, despite potentially higher risk of preoperative biliary drainagerelated pancreatitis due to SEMS [137,138].…”

Section: Recommendationmentioning

confidence: 99%

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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Main Recommendations 1 ESGE recommends against diagnostic/therapeutic papillectomy when adenoma is not proven.Strong recommendation, low quality evidence. 2 ESGE recommends endoscopic ultrasound and abdominal magnetic resonance cholangiopancreatography (MRCP) for staging of ampullary tumors.Strong recommendation, low quality evidence. 3 ESGE recommends endoscopic papillectomy in patients with ampullary adenoma without intraductal extension, because of good results regarding outcome (technical and clinical success, morbidity, and recurrence).Strong recommendation, moderate quality evidence. 4 ESGE recommends en bloc resection of ampullary adenomas up to 20–30 mm in diameter to achieve R0 resection, for optimizing the complete resection rate, providing optimal histopathology, and reduction of the recurrence rate after endoscopic papillectomy.Strong recommendation, low quality evidence. 5 ESGE suggests considering surgical treatment of ampullary adenomas when endoscopic resection is not feasible for technical reasons (e. g. diverticulum, size > 4 cm), and in the case of intraductal involvement (of > 20 mm). Surveillance thereafter is still mandatory.Weak recommendation, low quality evidence. 6 ESGE recommends direct snare resection without submucosal injection for endoscopic papillectomy.Strong recommendation, moderate quality evidence. 7 ESGE recommends prophylactic pancreatic duct stenting to reduce the risk of pancreatitis after endoscopic papillectomy.Strong recommendation, moderate quality evidence. 8 ESGE recommends long-term monitoring of patients after endoscopic papillectomy or surgical ampullectomy, based on duodenoscopy with biopsies of the scar and of any abnormal area, within the first 3 months, at 6 and 12 months, and thereafter yearly for at least 5 years.Strong recommendation, low quality evidence.

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Section: Recommendationmentioning

confidence: 99%

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

et al. 2021

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“…Self-expandable metallic stents are currently considered the standard of care in line with published data on biliary stent patency. 64…”

Section: Advances In Surgical Management Of Pancreatic Cancermentioning

confidence: 99%

An update on treatment options for pancreatic adenocarcinoma

et al. 2019

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Pancreatic cancer is one of the most lethal solid organ tumors. Due to the rising incidence, late diagnosis, and limited treatment options, it is expected to be the second leading cause of cancer deaths in high income countries in the next decade. The multidisciplinary treatment of this disease depends on the stage of cancer at diagnosis (resectable, borderline, locally advanced, and metastatic disease), and combines surgery, chemotherapy, chemoradiotherapy, and supportive care. The landscape of multidisciplinary pancreatic cancer treatment is changing rapidly, especially in locally advanced disease, and the number of treatment options in metastatic disease, including personalized medicine, innovative targets, immunotherapy, therapeutic vaccines, adoptive T-cell transfer, or stemness inhibitors, will probably expand in the near future. This review summarizes the current literature and provides an overview of how new therapies or new therapeutic strategies (neoadjuvant therapies, conversion surgery) will guide multidisciplinary disease management, future clinical trials, and, hopefully, will increase overall survival.

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“…It has been shown in previous studies that the frequency of EBD-related pancreatitis was higher in patients with SEMS as compared to plastic stents. 23,30 SEMS and particularly fully covered SEMS could hamper pancreatic duct out flow as compared to plastic stents which could increase the risk of post-ERCP pancreatitis. 31 In this nationwide study, it was not demonstrated that the post-ERCP pancreatitis rate was higher in patients with a SEMS, which was also confirmed by several other studies.…”

Section: Discussionmentioning

confidence: 99%

Nationwide practice and outcomes of endoscopic biliary drainage in resectable pancreatic head and periampullary cancer

Latenstein

Mackay

Huijgevoort

et al. 2021

HPB

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Background: Guidelines advise self-expanding metal stents (SEMS) over plastic stents in preoperative endoscopic biliary drainage (EBD) for malignant extrahepatic biliary obstruction. This study aims to assess nationwide practice and outcomes. Methods: Patients with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2017)(2018). Multivariable logistic and linear regression models were performed.Results: In total, 575/1056 patients (62.0%) underwent preoperative EBD: 246 SEMS (42.8%) and 329 plastic stents (57.2%). EBD-related complications were comparable between the groups (44/246 (17.9%) vs. 64/329 (19.5%), p = 0.607), including pancreatitis (22/246 (8.9%) vs. 25/329 (7.6%), p = 0.387). EBD-related cholangitis was reduced after SEMS placement (10/246 (4.1%) vs. 32/329 (9.7%), p = 0.043), which was confirmed in multivariable analysis (OR 0.36 95%CI 0.15-0.87, p = 0.023). Major postoperative complications did not differ (58/246 (23.6%) vs. 90/329 (27.4%), p = 0.316), whereas postoperative pancreatic fistula (24/246 (9.8%) vs. 61/329 (18.5%), p = 0.004; OR 0.50 95%CI 0.27-0.94, p = 0.031) and hospital stay (14.0 days vs. 17.4 days, p = 0.005; B 2.86 95%CI −5.16 to −0.57, p = 0.014) were less after SEMS placement. Conclusion:This study found that preoperative EBD frequently involved plastic stents. SEMS seemed associated with lower risks of cholangitis and less postoperative pancreatic fistula, but without an increased pancreatitis risk.

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Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review

Cited by 21 publications

References 28 publications

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

Endoscopic management of ampullary tumors: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

An update on treatment options for pancreatic adenocarcinoma

Nationwide practice and outcomes of endoscopic biliary drainage in resectable pancreatic head and periampullary cancer

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