Utility of a partially covered metal stent for salvage sealing therapy for bleeding caused by duodenal invasion of pancreatobiliary cancers: Case series

Abstract

Pancreatobiliary cancer‐related gastrointestinal bleeding caused by duodenal invasion can be a life‐threatening condition that is hard to control. It is unclear whether a covered self‐expandable metal stent (CSEMS) is useful for hemostasis of bleeding related to advanced pancreatobiliary cancer. The aim of this study was to evaluate the utility of a CSEMS for hemostasis of bleeding caused by duodenal invasion of pancreatobiliary cancer. Between January 2020 and January 2022, seven patients in whom a duodenal CSEMS was inserted to control pancreatobiliary cancer‐related bleeding were enrolled. The technical and clinical success rates with respect to hemostasis, procedure time, and adverse events were assessed. All patients were inoperable cases (six with pancreatic cancer [five, stage IV; one, stage III]; and one with gallbladder cancer [stage IV]) in whom CSEMs were inserted to treat refractory bleeding caused by cancer invasion. Hemostasis was achieved in all cases (100% [7/7]). The mean procedure time was 17 ± 7.9 min. There were no adverse events, including migration and rebleeding. No rebleeding occurred up until the time of death in any of the cases (mean follow‐up period, 73 ± 27 days). Deployment of duodenal CSEMS is a useful salvage therapy for bleeding caused by advanced pancreatobiliary cancer invasion.

Covered self‐expandable metallic stent placement for tumor bleeding from duodenal invasion in patients with unresectable pancreatic cancer

“…This minimally invasive approach is worth considering in this setting, where treatment options are limited. Complications associated with CSEMS placement, except food impaction in one patient, were absent, consistent with prior reports 8,9 . In conclusion, CSEMS placement is moderately useful for tumor bleeding in patients with uPC.…”

“…Although subsequent initiation of chemotherapy wasn't always possible, the impact of CSEMS placement on the quality of life makes it worthy of further investigation. Among the four patients in whom hemostasis was achieved, two developed rebleeding, contrasting previous studies with no rebleeding reports 8,9 . Both patients with rebleeding were undergoing uncovered SEMS placement for severe duodenal stenosis, suggesting a higher risk of rebleeding.…”

“…Complications associated with CSEMS placement, except food impaction in one patient, were absent, consistent with prior reports. 8,9 In conclusion, CSEMS placement is moderately useful for tumor bleeding in patients with uPC. Although its sustained hemostatic efficacy was limited, it proved safe and was beneficial in some cases, making it worthy of consideration in this setting with limited treatment options.…”

“…Yamashita et al reported that deployment of a duodenal CSEMS is a useful salvage therapy for bleeding caused by advanced pancreatobiliary cancer, with a hemostasis rate of 100%. 8 Other than that, only a few successful cases in patients with duodenal cancer and hepatocellular carcinoma have been reported. 9 In our study, hemostasis was achieved in four out of the six patients (67%).…”

“…Duodenal‐covered self‐expandable metallic stents (CSEMSs) placement has served as a useful treatment for tumor bleeding from the duodenum. However, the treatment outcomes have been reported from only a limited number of case reports of patients with a variety of cancers 7–9 . Herein, we report a series of 6 patients with uPC with tumor bleeding treated by CSEMS placement.…”