Occlusion rate and complications of plastic biliary stent placement in patients undergoing neoadjuvant chemoradiotherapy for pancreatic cancer with malignant biliary obstruction.

GOALS: Determine the stent patency rates, need for additional procedures, and complications of plastic biliary during neoadjuvant chemoradiotherapy.
BACKGROUND: Malignant biliary obstruction is a common feature of pancreatic ductal adenocarcinoma and palliative plastic biliary stents are often placed during neoadjuvant chemoradiotherapy before operative resection.
RESULTS: Forty-nine patients with resectable or locally advanced pancreatic adenocarcinoma and biliary obstruction had a plastic biliary stent placed endoscopically before receiving neoadjuvant chemoradiotherapy. The median time from stent placement to surgery was 150 days (range 71-227 d). Twenty-two patients (45%) had stents that remained patent throughout the course of neoadjuvant therapy. The remaining 27 patients (55%) required repeat ERCP for stent exchange, a median of 82.5 days after original stent placement (range 14-183 d). Fourteen were owing to abnormal liver enzymes or jaundice and 13 were owing to ascending cholangitis. Seventeen of these patients (63%) required hospitalization for either biliary obstruction or cholangitis. The median duration of hospital stay associated with stent exchange was 3 days (range 2-13 d).
CONCLUSIONS: Plastic biliary stents do not maintain patency during the time required for most patients to complete neoadjuvant chemoradiotherapy for pancreatic adenocarcinoma. Initially placing metallic stents to palliate malignant obstruction may be a safer and more cost-effective strategy.