Biliary Stenting for Malignant Biliary Obstruction Secondary to Pancreatic Cancer

Despite progresses made in oncology, pancreatic adenocarcinoma has a grim prognosis and commonly presents with rapidly advancing jaundice which requires endoscopic treatment.

Our objective was to show the perspective of a high ERCP volume dedicated Center on endoscopic stenting for malignant biliary obstruction consecutive to pancreatic cancer.

We conducted a retrospective study, between October 2017 and October 2020, and enrolled hospitalized patients within the Gastroenterology Department of the Clinical Emergency Hospital Bucharest, diagnosed with pancreatic cancer with secondary malignant biliary obstruction which underwent ERCP stenting.

We identified 269 patients which were admitted in our Clinic with a pancreatic lesion on computed tomography or magnetic resonance imaging and underwent EUS-FNA. 115 patients with proven pancreatic malignancy were selected and underwent ERCP stenting. 69 received plastic stents and 46 metal biliary stents, with the stent chosen based on patient's characteristics and availability at the time of the procedure. Per total 234 stents were used for relief of the cholestasis syndrome. The number of ERCP procedures was higher in the plastic stents group with a median of 1,8 whereas the SEMS had 1,5 range of procedures. Procedures were successful in 54 patients following plastic stents and 33 that underwent SEMS. At 30 days, overall mortality rate was of 5%.

Malignant obstruction secondary to pancreatic cancer is amenable by ERCP. However, choosing the right stents still varies. SEMS seem to be more efficient on a long term with fewer complications rates and further studies should be performed.