Efficacy of 6‐mm diameter fully covered self‐expandable metallic stents in preoperative biliary drainage for pancreatic ductal adenocarcinoma

Abstract

Objectives Plastic stents (PS) used for preoperative biliary drainage (PBD) of pancreatic ductal adenocarcinomas (PDAC) tend to be associated with a high incidence of recurrent biliary obstruction (RBO). Although 10‐mm diameter fully covered self‐expanding metallic stents (FCSEMS) have come into use, vigilance is still required to prevent complications, such as cholecystitis and surgical site infection. The present study examined the efficacy and safety of the 6‐mm diameter FCSEMS for PBD. Methods The present retrospective study compared the incidence of complications associated with the use of 6‐mm FCSEMS and PS. The inclusion criteria were a diagnosis of PDAC and preoperative endoscopic biliary tract drainage performed at our institution between April 2012 and June 2019. Results Of the 51 patients enrolled, 25 and 26 patients received a PS and a 6‐mm FCSEMS, respectively. The RBO incidence was significantly lower in the 6‐mm FCSEMS group (7.7%) than in the PS group (40.0%) ( p = 0.009), and time to RBO was significantly longer in the 6‐mm FCSEMS group (HR = 6.008, p = 0.021). The patency rate at three months after stent placement was significantly higher in the latter group (83.5% vs. 45.3%, p = 0.009, Log‐rank test). The groups did not differ significantly in terms of complications associated with PBD, such as cholecystitis and surgical site infection. Conclusion The present findings suggested that the 6‐mm FCSEMS may be an effective drainage device for use in PBD in PDAC treatment.

Outcomes of 6‐mm diameter fully covered self‐expandable metal stents for preoperative biliary drainage in pancreatic cancer

“…Surprisingly, stent migration was not observed in the 6-mm FCSEMS group. The rate of RBO and stent migration in the 6-mm group was higher in our study, probably due to the longer preoperative waiting period (111 days in our study vs. 38.5 days in the previous study 12 ). Harai et al 13 retrospectively compared 6-mm FCSEMSs with 10-mm FCSEMSs in patients with PC.…”

“…However, data are limited regarding the efficacy and safety of 6-mm diameter FCSEMSs for PBD. 12,13 Kataoka et al 12 retrospectively compared 6-mm FCSEMSs with plastic stents for PBD in 51 patients with PC. The incidence of RBO was significantly lower in the 6-mm FCSEMS group (7.7% vs. 40.0%, p = 0.009), despite an insignificant but higher rate of pancreatitis (15.4% vs. 4.0%, p = 0.350).…”

“…To date, only two studies have compared the efficacy and safety of SEMSs with 6-mm diameters to plastic stents or SEMSs with 10-mm diameters. 12,13 Therefore, we conducted this retrospective study to evaluate the efficacy and safety of 6-mm FCSEMSs compared to 10-mm FCSEMSs for PBD in patients with BR PC.…”

“…Recently, smaller diameter SEMSs have attracted attention, due to the perceived possibility of reducing stent‐related AEs. To date, only two studies have compared the efficacy and safety of SEMSs with 6‐mm diameters to plastic stents or SEMSs with 10‐mm diameters 12,13 …”

Comparison of 6-mm and 10-mm-diameter, fully-covered, self-expandable metallic stents for distal malignant biliary obstruction

“…Thus, the 6-mm FCSEMS may be useful in preoperative biliary drainage. Kataoka et al [28] compared the outcomes of a 6-mm FCSEMS and 7-8.5-French PS retrospectively in patients with preoperative pancreatic cancer; they found that TRBO was longer in the 6-mm FCSEMS group (P=0.02) than in the 7-8.5-French PS group, and stent-related complications were not significantly different between the groups (P=0.47). In summary, a 6-mm FCSEMS could be a well-balanced stent that reduces the risk of stent-related adverse events as much as a PS, while ensuring TRBO comparable to the standard 10-mm FCSEMS.…”