Use of self-expandable metallic stents for endoscopic biliary decompression decreases stent complications in pancreatic cancer patients receiving chemotherapy

Abstract Background Both plastic stents and self-expandable metallic stents (SEMSes) are used for endoscopic biliary decompression (BD) among patients with pancreatic cancer (PAC). Cholangitis or stent occlusion often interrupts or ends chemotherapy. We investigated cholangitis, stent occlusion, and chemotherapy interruption rates for SEMSes and plastic stents among patients receiving chemotherapy for PAC. Materials and methods We retrospectively analyzed data for 293 PAC patients who received a biliary stent at Helsinki University Hospital during 2000–2017. Patients received chemotherapy as palliative treatment (PT: n = 187) or neoadjuvant treatment (NAT: n = 106). Among participants, 229 had a plastic stent (PT: n = 138, NAT: n = 91) and 64 had a SEMS (PT: n = 49, NAT: n = 15). Results Overall, 15.6% (n = 10) of patients with SEMSes (PT: 20.4%, n = 10, NAT: 0%) and 53.0% (n = 121) of patients with plastic stents (PT: 69.3%, n = 95, NAT: 28.5%, n = 26) experienced one or more stent complications (p < 0.001). Cholangitis developed in 6.3% (n = 8) of PT patients with SEMSes. No patients with SEMSes receiving NAT (n = 15) experienced cholangitis. However, 31.9% (PT: 42.8%, n = 59, p = 0.001; NAT: 15.4%, n = 14, p = 0.211) of patients with plastic stents developed cholangitis. Among all patients receiving NAT or PT, cholangitis interrupted chemotherapy 6 times (9.4%) in SEMS patients and 61 times (26.6%) in plastic stent patients (p = 0.004). Stent occlusion without cholangitis interrupted NAT or PT 2 times (2.1%) in SEMS patients and 31 times (13.5%) in plastic stent patients (p = 0.023). Conclusions SEMS is recommended for BD among patients with PAC receiving chemotherapy. Among both PT and NAT patients, patients with SEMS experience a lower stent failure rate, lower rate of cholangitis, and fewer chemotherapy interruptions than patients with plastic stents.

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Patients receiving chemotherapy for pancreatic cancer (PAC) have a lower rate for stent complications when self-expandable metallic stents (SEMS) are used for endoscopic biliary decompression

HPB ◽

10.1016/j.hpb.2020.04.314 ◽

2020 ◽

Vol 22 ◽

pp. S329

Author(s):

S. Vehviläinen ◽

H. Seppänen ◽

A. Nurmi ◽

C. Haglund ◽

M. Udd ◽

...

Keyword(s):

Pancreatic Cancer ◽

Metallic Stents ◽

Biliary Decompression ◽

Expandable Metallic Stents ◽

Stent Complications

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Cholangioscopy-guided steroid injection for refractory post liver transplant anastomotic strictures: a rescue case series

Therapeutic Advances in Gastrointestinal Endoscopy ◽

10.1177/2631774519867786 ◽

2019 ◽

Vol 12 ◽

pp. 263177451986778 ◽

Cited By ~ 2

Author(s):

Tomazo Franzini ◽

Vitor M.T. Sagae ◽

Hugo G. Guedes ◽

Paulo Sakai ◽

Daniel R. Waisberg ◽

...

Keyword(s):

Liver Transplant ◽

Steroid Injection ◽

Revisional Surgery ◽

Balloon Dilation ◽

Metallic Stents ◽

Plastic Stents ◽

Biliary Strictures ◽

Anastomotic Strictures ◽

Expandable Metallic Stents

Background and aims: Post liver transplant biliary anastomotic strictures have traditionally been treated with balloon dilation and multiple plastic stents. Fully covered self-expandable metallic stents may be used as an initial alternative or after multiple plastic stents failure. Refractory strictures can occur in 10–22% and require revisional surgery. Alternatively, cholangioscopy allows direct visualization and therapeutic approaches. We aimed to assess the feasibility, safety, and efficacy of balloon dilation combined with cholangioscopy-guided steroid injection for the treatment of refractory anastomotic biliary strictures. Methods: Three post-orthotopic liver transplant patients who failed standard treatment of their biliary anastomotic strictures underwent endoscopic retrograde cholangiopancreatography with balloon dilation followed by cholangioscopy-guided steroid injection at a tertiary care center. Patients had follow-up with images and laboratorial tests to evaluate for residual stricture. Results: Technical success of balloon dilation + cholangioscopy-guided steroid injection was achieved in all patients. Cholangioscopy permitted accurate evaluation of bile ducts and precise localization for steroid injection. No adverse events occurred. Mean follow-up was 26 months. Two patients are stent free and remain well in follow-up, with no signs of biliary obstruction. No further therapeutic endoscopic procedures or revisional surgery were required. One patient did not respond to balloon dilation + cholangioscopy-guided steroid injection after 11 months of follow-up and required repeat balloon dilation of new strictures above the anastomosis. Conclusion: Cholangioscopy-guided steroid injection combined with balloon dilation in the treatment of refractory post liver transplant strictures is feasible and safe. This method may be used as a rescue alternative before surgical approach. Randomized controlled trials comparing balloon dilation + cholangioscopy-guided steroid injection to fully covered self-expandable metallic stents are needed to determine the role of this treatment for anastomotic biliary strictures.

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Impact of adjuvant hepatic arterial chemoinfusion using high-dose 5-fluorouracil with systemic gemcitabine for pancreatic cancer: A propensity score–matched analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.402 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 402-402

Author(s):

Kota Nakamura ◽

Masayuki Sho ◽

Takahiro Akahori ◽

Minako Nagai ◽

Kenji Nakagawa ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Propensity Score ◽

Neoadjuvant Treatment ◽

University Hospital ◽

Control Group ◽

High Dose ◽

Resectable Pancreatic Cancer ◽

Borderline Resectable ◽

Borderline Resectable Pancreatic Cancer

402 Background: The aim of this retrospective study was to evaluate the efficacy of adjuvant hepatic arterial infusion chemotherapy (HAI) using high-dose 5-fluorouracil with systemic gemcitabine on prognosis of resected pancreatic cancer. Methods: Between January 2006 and April 2016, 298 patients underwent elective pancreatic resection for resectable or borderline resectable pancreatic cancer at Nara Medical University Hospital. Patients who received adjuvant HAI plus systemic gemcitabine after surgery (HAI group) were compared with those who received systemic chemotherapy alone (control group). Patients were propensity score matched for age, sex, ASA score, CA19-9, NCCN resectability status, neoadjuvant treatment, surgical procedure, portal vein invasion, T stage, N stage, and margin status. Results: 224 patients with resectable or borderline resectable pancreatic cancer were enrolled in this study. 151 patients in the HAI group and 73 patients in the control group were included. Propensity score matching analysis was used to identify 63 well-balanced patients in each group for overall survival comparison. The estimate overall survival (OS) for patients treated with HAI was longer than patients without HAI in both the whole cohort (median OS, 54 vs. 24 months, respectively; P < 0.001) or matched cohort (median OS, 58 vs. 26 months, respectively; P = 0.003). The liver was only recurrence site in which significant decrease was observed in the HAI group compared to the control group ( P = 0.031). In the multivariate analysis, adjuvant chemotherapy without HAI were independently associated with worse outcome in the whole cohort. A total of 127 patients in the HAI group (84%) had completed the planned dose of HAI. The remaining 24 patients stopped treatment before the end of the planned cycle due to catheter-associated complications in 9 (6.0%) and development of liver abscess in 2 (1.3%). No treatment-related deaths occurred. Conclusions: The efficacy of hepatic arterial chemoinfusion as adjuvant treatment for resectable pancreatic cancer should be revisited.

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Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

Gastroenterology Research and Practice ◽

10.1155/2016/7968201 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 5

Author(s):

Tomofumi Tsuboi ◽

Tamito Sasaki ◽

Masahiro Serikawa ◽

Yasutaka Ishii ◽

Teruo Mouri ◽

...

Keyword(s):

Pancreatic Cancer ◽

Biliary Drainage ◽

Preoperative Biliary Drainage ◽

Metallic Stents ◽

Plastic Stents ◽

Complication Rates ◽

Metallic Stent ◽

Resectable Pancreatic Cancer ◽

Borderline Resectable ◽

Hospitalization Costs

Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC).Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery.Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p=0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test,p=0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery.Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

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Superiority of Self-Expandable Metallic Stents (SEMS) Over Plastic Stents (PS) in Treatment of Malignant Distal Biliary Strictures

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2020.12.020 ◽

2020 ◽

Author(s):

Sunguk Jang ◽

Tyler Stevens ◽

Mansour A. Parsi ◽

Amit Bhatt ◽

Adam Kichler ◽

...

Keyword(s):

Metallic Stents ◽

Plastic Stents ◽

Biliary Strictures ◽

Expandable Metallic Stents

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Best period to replace or change plastic stents with self-expandable metallic stents using multivariate competing risk regression analysis

Scientific Reports ◽

10.1038/s41598-020-70081-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Masafumi Chiba ◽

Masayuki Kato ◽

Yuji Kinoshita ◽

Nana Shimamoto ◽

Youichi Tomita ◽

...

Keyword(s):

Regression Analysis ◽

Metallic Stents ◽

Competing Risk ◽

Plastic Stents ◽

Expandable Metallic Stents

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Comparative Study between Plastic and Metallic Stents for Biliary Decompression in Patients with Distal Biliary Obstruction

Gastroenterology Research and Practice ◽

10.1155/2017/7621821 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

João Guilherme G. Cabral ◽

Eloy Taglieri ◽

Adriane Pelosof ◽

Daniel Rosendo ◽

José Celso Ardengh

Keyword(s):

Biliary Obstruction ◽

Statistical Difference ◽

Metallic Stents ◽

Plastic Stents ◽

Survival Curves ◽

Biliary Decompression ◽

Sems Group ◽

Retrospective Comparison ◽

Number Of Patients

This paper presents a retrospective comparison of plastic versus metallic stents in the drainage of malignant distal biliary obstructions. We compared single plastic stents (SPS), multiple plastic stents (MPS), and metallic stents (SEMS) regarding clinical decrease of TB < 2.0 mg/dL, long-term patency, and adverse event. 58 patients (38 women) with MDBO were included. Diagnoses were 44 pancreatic adenocarcinoma (74.6%), 9 metastasis (15.5%), 3 pancreatic neuroendocrine tumors (5.1%), and 2 adenocarcinoma in the major papilla (3.4%). The number of patients included in the SPS, MPS, and SEMS was 17, 6, and 35, respectively. Comparing the survival curves with respect to obstruction, we observed a lower mean permeability of the SPS compared to that of the MPS with p<0.003 and of the SEMS group (p<0.01). There was no statistical difference between the use of MPS, despite the small number of patients compared to the use of SEMS (p<0.13) to reach the satisfactory levels of bilirubin.

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Impact of biliary metal and plastic stents on preoperative staging for pancreatic cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.646 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 646-646

Author(s):

Hachem Hachem ◽

Sanjay S. Reddy ◽

Jeffrey Tokar ◽

Eileen O'Halloran ◽

Jennifer Higa ◽

...

Keyword(s):

Pancreatic Cancer ◽

Biliary Drainage ◽

Neoadjuvant Treatment ◽

Surgical Pathology ◽

Plastic Stents ◽

Metal Stents ◽

Cross Sectional ◽

Stent Type ◽

Cross Sectional Imaging ◽

Sectional Imaging

646 Background: Multiple studies have shown the superiority of biliary metal compared with plastic stents for pre-operative (preop) biliary drainage in pancreatic cancer (PDAC). Despite the importance of preop cross-sectional imaging, particularly in the era of neoadjuvant treatment, there is no data on the impact of such stents on the quality of preop cross-sectional imaging. We hypothesis, that biliary metal stents negatively impact the accuracy of preop cross-sectional imaging in pancreatic cancer, with unknown impact for the adequacy of surgical candidacy. Methods: Data of all patients undergoing pancreatic resection for PDAC between 1/1/2012 and 1/1/2018 was retrospectively abstracted. Clinical staging based on preop cross-sectional imaging following biliary stent placement (within 2 months prior surgical resection) was compared with the surgical pathology (staging gold standard). Accuracy of clinical and surgical pathology staging was compared. Logistic regression was performed to control for biliary stent type, neoadjuvant treatment and patient baseline characteristics including BMI and type of imaging. Results: 312 patients underwent pancreatic resections. 118 patients required preop biliary drainage in setting of PDAC, including 92 ERCPs of which 83 were successful (46 plastic and 37 metal stents). 76 patients underwent neoadjuvant chemoradiation therapy. Surgical pathology revealed following stages: 0 n = 4, 1A n = 5, 1B n = 8, 2A n = 20, 2B n = 24, 3 n = 1, 4 n = 14. 96% underwent preop CT and 4% MRI pancreas protocol imaging. Exact correlation between clinical and surgical pathology was present in only 48% of cases (57% plastic, 46% metal stent), with 28% of clinical T overstaging, 4% clinical T understaging, 16% clinical N understaging and 4% unable to stage due to artefacts. More importantly, 8% patients were incorrectly staged to be surgical candidates (14% plastic, 6% metal). Controlling for stent type, neoadjuvant treatment and BMI did not impact preop cross-sectional imaging accuracy. Conclusions: Despite their impact on preop cross-imaging biliary metal stents did not negatively impact the accuracy and patient selection for surgical candidacy compared with biliary plastic stents in PDAC.

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