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Self-Expanding Metal Stents (SEMS) for Preoperative Biliary Decompression in Patients with Resectable and Borderline-Resectable Pancreatic Cancer: Outcomes in 241 Patients

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Abstract

Background and Aim

Obstructive jaundice caused by distal biliary obstruction can present in up to 70 % of patients with localized cancer of the head of the pancreas. The aim of this study was to report our experience in using self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline resectable carcinoma of the pancreatic head.

Methods

We performed a retrospective study evaluating patients from two tertiary referral centers. Two-hundred and forty-one patients with resectable and borderline resectable pancreatic carcinoma underwent ERCP with metal biliary stent placement between September 2006 and August 2011. We assessed the effectiveness of SEMS to adequately decompress the biliary tree, procedural success, patient survival, stent patency, and stent-related complications.

Results

Two-hundred and forty-one patients were evaluated [123 male, mean age (±SD) 67.4 ± 9.8 years; resectable 174, borderline resectable 67]. Patients with borderline-resectable cancer underwent neoadjuvant therapy and restaging before possible curative surgery. Successful placement of a metal biliary stent was achieved in all patients and improved jaundice. Patients were followed for mean duration of 6.3 months. The overall survival was 49 % at 27 months. Fourteen (5.8 %) patients experienced stent occlusion; the mean time to stent occlusion was 6.6 (range 1–20) months. Immediate complications included: post-ERCP pancreatitis (n = 14), stent migration (n = 3), and duodenal perforation (n = 3). Long-term complications included stent migration (n = 9) and hepatic abscess (n = 1). A total of 144/174 patients deemed to have resectable cancer at time of diagnosis underwent curative surgery. Due to disease progression or the discovery of metastasis after neoadjuvant therapy, only 22/67 patients with borderline-resectable cancer underwent curative surgery.

Conclusions

SEMS should be considered for patients with obstructive jaundice and resectable or borderline resectable pancreatic cancer, especially if surgery is not planned immediately as a result of preoperative chemoradiation. These stents appear to be safe and effective.

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Acknowledgments

This study was funded entirely through existing intramural funds and salary support.

Conflict of interest

Drs. Siddiqui, Mehendiratta, Loren, and Kowalski are consultans to Boston Scientific and Cook Endoscopy. Drs. Adler and Fang are consultants to Boston Scientific and Merit.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Ali A. Siddiqui, Vaibhav Mehendiratta, David Loren & Thomas Kowalski

  2. Division of Gastroenterology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA

    John Fang, Kristen Hilden & Douglas G. Adler

Authors
  1. Ali A. Siddiqui
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  2. Vaibhav Mehendiratta
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  3. David Loren
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  4. Thomas Kowalski
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  5. John Fang
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  6. Kristen Hilden
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  7. Douglas G. Adler
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Corresponding author

Correspondence to Douglas G. Adler.

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Siddiqui, A.A., Mehendiratta, V., Loren, D. et al. Self-Expanding Metal Stents (SEMS) for Preoperative Biliary Decompression in Patients with Resectable and Borderline-Resectable Pancreatic Cancer: Outcomes in 241 Patients. Dig Dis Sci 58, 1744–1750 (2013). https://doi.org/10.1007/s10620-012-2482-z

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  • DOI: https://doi.org/10.1007/s10620-012-2482-z

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