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

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 includin...

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Autores principales: Takeda, Tsuyoshi, Sasaki, Takashi, Mie, Takafumi, Furukawa, Takaaki, Kanata, Ryo, Kasuga, Akiyoshi, Matsuyama, Masato, Ozaka, Masato, Sasahira, Naoki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Georg Thieme Verlag KG 2020
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581474/
https://www.ncbi.nlm.nih.gov/pubmed/33140016
http://dx.doi.org/10.1055/a-1244-1989
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author Takeda, Tsuyoshi
Sasaki, Takashi
Mie, Takafumi
Furukawa, Takaaki
Kanata, Ryo
Kasuga, Akiyoshi
Matsuyama, Masato
Ozaka, Masato
Sasahira, Naoki
author_facet Takeda, Tsuyoshi
Sasaki, Takashi
Mie, Takafumi
Furukawa, Takaaki
Kanata, Ryo
Kasuga, Akiyoshi
Matsuyama, Masato
Ozaka, Masato
Sasahira, Naoki
author_sort Takeda, Tsuyoshi
collection PubMed
description 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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spelling pubmed-75814742020-11-01 Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer Takeda, Tsuyoshi Sasaki, Takashi Mie, Takafumi Furukawa, Takaaki Kanata, Ryo Kasuga, Akiyoshi Matsuyama, Masato Ozaka, Masato Sasahira, Naoki Endosc Int Open 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. Georg Thieme Verlag KG 2020-11 2020-10-22 /pmc/articles/PMC7581474/ /pubmed/33140016 http://dx.doi.org/10.1055/a-1244-1989 Text en The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/) https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Takeda, Tsuyoshi
Sasaki, Takashi
Mie, Takafumi
Furukawa, Takaaki
Kanata, Ryo
Kasuga, Akiyoshi
Matsuyama, Masato
Ozaka, Masato
Sasahira, Naoki
Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
title Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
title_full Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
title_fullStr Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
title_full_unstemmed Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
title_short Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
title_sort novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581474/
https://www.ncbi.nlm.nih.gov/pubmed/33140016
http://dx.doi.org/10.1055/a-1244-1989
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