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Long-term Outcome of Biliary and Duodenal Stents in Palliative Treatment of Patients with Unresectable Adenocarcinoma of the Head of Pancreas

Maire, Frédérique, M.D.; Hammel, Pascal, M.D.; Ponsot, Philippe, M.D.; Aubert, Alain, M.D.; O'Toole, Dermot, M.D.; Hentic, Olivia, M.D.; Levy, Philippe, M.D.; Ruszniewski, Philippe, M.D.

American Journal of Gastroenterology: April 2006 - Volume 101 - Issue 4 - p 735–742

BACKGROUND Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown.

AIM To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer.

PATIENTS AND METHODS All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival.

RESULTS One hundred patients, median age 65 yr (32–85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7–29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4–21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5–15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment.

CONCLUSION Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.

Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France

Reprint requests and correspondence: Pascal Hammel, Pôle des Maladies de l' Appareil Digestif, Hôpital Beaujon, AP-HP, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France.

Received February 23, 2005; accepted October 17, 2005.

© The American College of Gastroenterology 2006. All Rights Reserved.
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