Palliative biliary stents for obstructing pancreatic carcinoma

Abstract

Endoscopic metal stents are the intervention of choice at present in patients with malignant distal obstructive jaundice due to pancreatic carcinoma. In patients with short predicted survival, their patency benefits over plastic stents may not be realised. Further RCTs are needed to determine the optimal stent type for these patients.

Management of Suspected Malignant Biliary Obstruction With Same Session Eus/Ercp – Retrospective Study of a Single Center Experience

“…In a meta-analysis published by Hongyu Li et al 18 , the same session approach was found to have a higher diagnostic sensitivity (75.6%) than EUS-FNB alone (73.1%). Regarding the concern that ERCP performed after EUS may be technically challenging because of edema induced by the preceding biopsy, we found a rate of technical success equal to that reported in the literature for ERCP alone 19 . The same session approach has the advantage of a short time between the procedure and the initiation of pancreatic ductal adenocarcinoma or cholangiocarcinoma specific therapies, such as surgery, chemotherapy and radiotherapy, with a great impact on institutions unable to efficiently coordinate and manage multidisciplinary patients with biliopancreatic malignancies.…”

Management of Suspected Malignant Biliary Obstruction With Same Session Eus/Ercp – Retrospective Study of a Single Center Experience

“…In a meta-analysis published by Hongyu Li et al 18 , the same session approach was found to have a higher diagnostic sensitivity (75.6%) than EUS-FNB alone (73.1%). Regarding the concern that ERCP performed after EUS may be technically challenging because of edema induced by the preceding biopsy, we found a rate of technical success equal to that reported in the literature for ERCP alone 19 . The same session approach has the advantage of a short time between the procedure and the initiation of pancreatic ductal adenocarcinoma or cholangiocarcinoma specific therapies, such as surgery, chemotherapy and radiotherapy, with a great impact on institutions unable to efficiently coordinate and manage multidisciplinary patients with biliopancreatic malignancies.…”

Endoscopic Palliative Treatment for Duodenal and Biliary Obstruction in Advanced Periampullary Malignancy

“…In case of failure, alternatives include attempting a second endoscopic retrograde cholangiopancreatography catheterization, performing decompression via a percutaneous transhepatic route, or using endoscopic ultrasound guidance [ 9 , 10 ]. Symptomatic duodenal stenosis or obstruction due to tumor invasion can also occur in patients with a biliary stent in situ.…”

“…Once it is confirmed that the biliary stent is functioning properly, or after replacing an occluded prosthesis, a duodenal stent can usually be placed without any difficulty. Duodenal stricture is treated endoscopically by the insertion of an uncovered self-expanding metallic stent into the duodenal lumen through an endoscope with a large working channel [ 10 ]. A duodenal stent placement must always be done post-biliary stent placement [ 10 , 11 ].…”

“…Duodenal stricture is treated endoscopically by the insertion of an uncovered self-expanding metallic stent into the duodenal lumen through an endoscope with a large working channel [ 10 ]. A duodenal stent placement must always be done post-biliary stent placement [ 10 , 11 ].…”

Clinical outcomes of hepaticojejunostomy and ERCP endoscopic bile duct stent implantation in the treatment of malignant obstructive jaundice: a retrospective analysis

“…Because of the poor support, plastic stents are easy to be compressed and deformed by tumor growth when used in the treatment of malignant biliary obstruction and jaundice reduction. The diameter of metal stent is several times bigger than that of the plastic stent after expansion, but is more expensive [23][24][25] . Also, metal stents have less bacterial proliferation and xation surfaces, it is not conducive to bio lm formation and cholestasis, which may contribute to lower recurrence rate of jaundice compared with plastic stent [24,26,27] .…”

Management of Suspected Malignant Biliary Obstruction With Same Session Eus/Ercp – Retrospective Study of a Single Center Experience

“…In a meta-analysis published by Hongyu Li et al 18 , the same session approach was found to have a higher diagnostic sensitivity (75.6%) than EUS-FNB alone (73.1%). Regarding the concern that ERCP performed after EUS may be technically challenging because of edema induced by the preceding biopsy, we found a rate of technical success equal to that reported in the literature for ERCP alone 19 . The same session approach has the advantage of a short time between the procedure and the initiation of pancreatic ductal adenocarcinoma or cholangiocarcinoma specific therapies, such as surgery, chemotherapy and radiotherapy, with a great impact on institutions unable to efficiently coordinate and manage multidisciplinary patients with biliopancreatic malignancies.…”

Endoscopic Palliative Treatment for Duodenal and Biliary Obstruction in Advanced Periampullary Malignancy

“…In case of failure, alternatives include attempting a second endoscopic retrograde cholangiopancreatography catheterization, performing decompression via a percutaneous transhepatic route, or using endoscopic ultrasound guidance [ 9 , 10 ]. Symptomatic duodenal stenosis or obstruction due to tumor invasion can also occur in patients with a biliary stent in situ.…”

“…Once it is confirmed that the biliary stent is functioning properly, or after replacing an occluded prosthesis, a duodenal stent can usually be placed without any difficulty. Duodenal stricture is treated endoscopically by the insertion of an uncovered self-expanding metallic stent into the duodenal lumen through an endoscope with a large working channel [ 10 ]. A duodenal stent placement must always be done post-biliary stent placement [ 10 , 11 ].…”

“…Duodenal stricture is treated endoscopically by the insertion of an uncovered self-expanding metallic stent into the duodenal lumen through an endoscope with a large working channel [ 10 ]. A duodenal stent placement must always be done post-biliary stent placement [ 10 , 11 ].…”

Clinical outcomes of hepaticojejunostomy and ERCP endoscopic bile duct stent implantation in the treatment of malignant obstructive jaundice: a retrospective analysis

“…Because of the poor support, plastic stents are easy to be compressed and deformed by tumor growth when used in the treatment of malignant biliary obstruction and jaundice reduction. The diameter of metal stent is several times bigger than that of the plastic stent after expansion, but is more expensive [23][24][25] . Also, metal stents have less bacterial proliferation and xation surfaces, it is not conducive to bio lm formation and cholestasis, which may contribute to lower recurrence rate of jaundice compared with plastic stent [24,26,27] .…”

Management of Suspected Malignant Biliary Obstruction With Same Session Eus/Ercp – Retrospective Study of a Single Center Experience

“…In a meta-analysis published by Hongyu Li et al 18 , the same session approach was found to have a higher diagnostic sensitivity (75.6%) than EUS-FNB alone (73.1%). Regarding the concern that ERCP performed after EUS may be technically challenging because of edema induced by the preceding biopsy, we found a rate of technical success equal to that reported in the literature for ERCP alone 19 . The same session approach has the advantage of a short time between the procedure and the initiation of pancreatic ductal adenocarcinoma or cholangiocarcinoma specific therapies, such as surgery, chemotherapy and radiotherapy, with a great impact on institutions unable to efficiently coordinate and manage multidisciplinary patients with biliopancreatic malignancies.…”

Endoscopic Palliative Treatment for Duodenal and Biliary Obstruction in Advanced Periampullary Malignancy

“…In case of failure, alternatives include attempting a second endoscopic retrograde cholangiopancreatography catheterization, performing decompression via a percutaneous transhepatic route, or using endoscopic ultrasound guidance [ 9 , 10 ]. Symptomatic duodenal stenosis or obstruction due to tumor invasion can also occur in patients with a biliary stent in situ.…”

“…Once it is confirmed that the biliary stent is functioning properly, or after replacing an occluded prosthesis, a duodenal stent can usually be placed without any difficulty. Duodenal stricture is treated endoscopically by the insertion of an uncovered self-expanding metallic stent into the duodenal lumen through an endoscope with a large working channel [ 10 ]. A duodenal stent placement must always be done post-biliary stent placement [ 10 , 11 ].…”

“…Duodenal stricture is treated endoscopically by the insertion of an uncovered self-expanding metallic stent into the duodenal lumen through an endoscope with a large working channel [ 10 ]. A duodenal stent placement must always be done post-biliary stent placement [ 10 , 11 ].…”

Clinical outcomes of hepaticojejunostomy and ERCP endoscopic bile duct stent implantation in the treatment of malignant obstructive jaundice: a retrospective analysis

“…Because of the poor support, plastic stents are easy to be compressed and deformed by tumor growth when used in the treatment of malignant biliary obstruction and jaundice reduction. The diameter of metal stent is several times bigger than that of the plastic stent after expansion, but is more expensive [23][24][25] . Also, metal stents have less bacterial proliferation and xation surfaces, it is not conducive to bio lm formation and cholestasis, which may contribute to lower recurrence rate of jaundice compared with plastic stent [24,26,27] .…”