Sequential or Simultaneous Placement of Self-expandable Metallic Stents for Palliation of Malignant Biliary and Duodenal Obstruction Due to Unresectable Pancreatic Head Carcinoma

Abstract

Placement of self-expandable metal stents is a safe and efficacious palliation method for biliary and duodenal obstruction due to unresectable pancreatic head carcinoma. The majority of patients do not require reintervention and those who require can usually be managed nonoperatively.

Self-Expanding Metal Stents for Pancreatic Tumors: Expanding the Possibilities, Decreasing the Costs and Risks

“…All the patients were managed endoscopically without requiring surgical intervention and without affecting overall mortality. Average stent patency was 34 and 27 weeks for biliary and duodenal stents, respectively, comparable to the results reported in previous smaller studies [6][7][8][9][10][11]. No procedure-related mortality was noted.…”

“…This article, in addition to prior smaller published studies [6][7][8][9][10][11], strengthens the evidence supporting endoscopic rather than surgical management of patients with advanced, unresectable pancreatic or peri-pancreatic cancer who develop biliary and duodenal obstruction [12]. Although concerns over technical success have limited application of these procedures in the past, technical and clinical success after endoscopic intervention in all studies is excellent when performed in tertiary referral centers.…”

“…Moreover, higher rates of biliary stent dysfunction were reported when duodenal stents were present [6]. Recently, however, several small case series have reported that simultaneous biliary and enteral SEMS placement is associated with 82-100 % technical and clinical success and a 15-58 % complication rate, mainly stent stenosis, although many of these studies included a small number of patients and had minimal post-procedure evaluation [7][8][9][10][11].In this issue of Digestive Diseases and Sciences, Canena et al [12] provide additional evidence that simultaneous biliary and duodenal SEMS are an acceptable therapeutic option for patients with unresectable pancreatic or peripancreatic malignancy. Canena et al enrolled 50 patients, a larger sample size than reported in previous studies, providing a statistically more robust database.…”

“…Moreover, higher rates of biliary stent dysfunction were reported when duodenal stents were present [6]. Recently, however, several small case series have reported that simultaneous biliary and enteral SEMS placement is associated with 82-100 % technical and clinical success and a 15-58 % complication rate, mainly stent stenosis, although many of these studies included a small number of patients and had minimal post-procedure evaluation [7][8][9][10][11].…”

“…Complication rates from endoscopic procedures are reasonable and can be managed endoscopically without influencing overall life expectancy. Furthermore, while concerns over enteral stents increasing the failure rate of biliary stents are warranted, such complications do not seem to increase mortality even when cholangitis develops [6][7][8][9][10][11]. In addition, cost-comparison analyses between surgical and endoscopic therapy have favored endoscopic management.…”