Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer

Antireflux Metal Stent as a First-Line Metal Stent for Distal Malignant Biliary Obstruction: A Pilot Study

“…As shown in our previous study, duodenal tumor invasion was associated with an increased risk of early SEMS dysfunction due to the duodenobiliary reflux enhanced by the stagnation of duodenal contents based on narrowing of the duodenum itself or impaired peristalsis 30. We also found that patients with an indwelling duodenal SEMS were predisposed to a further enhanced risk of SEMS dysfunction due to the duodenobiliary reflux 34.…”

“…Given these circumstances, the duodenobiliary reflux currently remains a main cause of the dysfunction of covered SEMS. In most patients, SEMS should be placed with the distal end in the duodenum to cover the biliary stricture sufficiently,30 leading to the loss of the sphincter function and the resultant free reflux of duodenal contents (food residue and duodenal juice) into the bile duct 10–12. The duodenobiliary reflux occasionally provokes SEMS occlusion due to sludge or food impaction and ascending cholangitis 10…”

A Case Series: Outcomes of Endoscopic Biliary Self-Expandable Metal Stent for Malignant Biliary Obstruction with Surgically Altered Anatomy

“…A previous study reported that 21 % of early stent obstructions (within 3 months) were caused by food impaction, and 14 % were caused by sludge in patients with pancreatic cancer who underwent biliary metal stent placement [23]. In patients who have undergone gastrointestinal reconstruction, it is difficult for food to reach the excluded limb of the gastrointestinal tract, and this may account for the low rate of obstruction caused by food impaction and food debris in such patients.…”

Effectiveness of endoscopic duodenal stenting for the management of patients with unresectable pancreatic cancer

“…Togawa et al reported that the insertion of a new metallic stent should be considered as the treatment of choice for the management of dysfunctional biliary metallic stents [19]. However, a recent study reported that duodenal infiltration is a risk factor for the obstruction of biliary metal stents within 3 months [20]. Thus, the treatment of obstruction in the descending part in patients with carcinoma of the head of the pancreas, which often causes obstructions in both the duodenum and the bile duct, should be carefully considered; for example, bypass surgery may need to be considered.…”