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. 2020 Nov;8(11):E1603-E1610.
doi: 10.1055/a-1244-1989. Epub 2020 Oct 22.

Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer

Tsuyoshi Takeda  1 , Takashi Sasaki  1 , Takafumi Mie  1 , Takaaki Furukawa  1 , Ryo Kanata  1 , Akiyoshi Kasuga  1 , Masato Matsuyama  1 , Masato Ozaka  1 , Naoki Sasahira  1
Affiliations

Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer

Tsuyoshi Takeda et al. Endosc Int Open. 2020 Nov.

Abstract

Background and study aims Self-expandable metallic stents (SEMS) are now widely used even for patients with borderline resectable (BR) pancreatic cancer (PC), as neoadjuvant therapy has become common. Therefore, we conducted this study to evaluate safety of SEMS placement in the population including BR PC and to explore risk factors for recurrent biliary obstruction (RBO), pancreatitis, and cholecystitis. Patients and methods We retrospectively investigated consecutive patients with PC who received initial SEMS between January 2015 and March 2019. We compared time to RBO (TRBO), causes of RBO, and stent-related adverse events (AEs) according to resectability status. Univariate and multivariate analyses were performed to explore risk factors for TRBO, pancreatitis, and cholecystitis. Results A total of 135 patients were included (BR 31 and unresectable [UR] 104). Stent-related AEs occurred in 39 patients: pancreatitis 14 (mild/moderate/severe 1/6/7), cholecystitis 12, and non-occluding cholangitis 13. TRBO, causes of RBO, and stent-related AEs were not significantly different according to resectability status. Overall rate of RBO was higher in UR PC due to the longer follow-up period. Sharp common bile duct (CBD) angulation was an independent risk factor for short duration of TRBO. High pancreatic volume index and SEMS of high axial force were independent risk factors for pancreatitis, whereas tumor involvement to orifice of cystic duct was the only risk factor for cholecystitis. Conclusions We demonstrated that SEMS can be safely deployed even in patients with BR PC. Sharp CBD angulation and high pancreatic volume index were identified as novel risk factors for RBO and pancreatitis, respectively, after SEMS placement.

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Conflict of interest statement

Competing interests Dr. Sasahira has received honoraria from Boston Scientific Japan and Cook Medical Japan. Dr. Sasaki has received honoraria from Boston Scientific Japan, Cook Medical Japan, and Century Medical Inc.

Figures

Fig. 1 a
Fig. 1 a
Measurement of CBD angulation and b estimated value of normal pancreas volume. CBD, common bile duct.
Fig. 2
Fig. 2
Patient flowchart. SEMS, self-expandable metallic stent; BR, borderline resectable; UR, unresectable.
Fig. 3
Fig. 3
Kaplan-Meier curves of time to recurrent biliary obstruction according to resectability status. BR, borderline resectable; UR, unresectable.
See this image and copyright information in PMC

References

    1. Siegel R L, Miller K D, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67:7–30. - PubMed
    1. Lucas A L, Malvezzi M, Carioli G et al.Global Trends in pancreatic cancer mortality from 1980 through 2013 and predictions for 2017. Clin Gastroenterol Hepatol. 2016;14:1452–INF. - PMC - PubMed
    1. Sasaki T, Kanata R, Yamada I et al.Improvement of treatment outcomes for metastatic pancreatic cancer: a real-world data analysis. In Vivo. 2019;33:271–276. - PMC - PubMed
    1. Schnelldorfer T, Ware A L, Sarr M G et al.Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–462. - PubMed
    1. Cameron J L, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220:530–536. - PubMed