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Comparing the 14-mm uncovered and 10-mm covered metal stents in patients with distal biliary obstruction caused by unresectable pancreatic cancer: a multicenter retrospective study

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Abstract

Background

Endoscopic biliary drainage using metal stent (MSs) is an established palliative treatment for patients with unresectable malignant distal biliary obstruction (MDBO). However, a major drawback of MS is recurrent biliary obstruction (RBO). Uncovered MSs with a diameter of 14 mm (UMS-14) were developed to overcome this. We aimed to compare the clinical outcomes of UMS-14 with those of conventional covered MSs having a diameter of 10 mm (CMS-10).

Methods

Consecutive patients with MDBO caused by unresectable pancreatic cancer, who underwent UMS-14 or CMS-10 placement at two tertiary-care centers, were retrospectively examined according to the Tokyo Criteria 2014.

Results

Two hundred and thirty-eight patients who underwent UMS-14 (the UMS-14 group, n = 80) or CMS-10 (the CMS-10 group, n = 158) over a 62-month period were included. The technical and clinical success rates were similar between the two groups. RBO occurred in 20 (25%) and 59 (37%) patients of the UMS-14 and CMS-10 groups, respectively (p = 0.06). Median time till RBO was significantly longer in the UMS-14 group than in the CMS-10 group (not reached vs. 290 days, p = 0.04). Multivariate analysis revealed that CMS-10 placement was an independent risk factor for RBO (hazard ratio: 1.66, 95% confidence interval: 1.00–2.76). The incidence of early complications, including pancreatitis, and the overall survival (UMS-14 vs. CMS-10: 169 vs. 167 days, p = 0.83) were comparable between the two groups.

Conclusions

UMS-14 stents were safe and effective for treating patients with MDBO secondary to unresectable pancreatic cancer. The insertion of UMS-14 is recommended, because it is less likely to get occluded as compared to CMS-10.

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Acknowledgements

We thank all members of the Division of Endoscopy, Shizuoka Cancer Center, for the help rendered to this study.

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Authors and Affiliations

  1. Division of Endoscopy, Shizuoka Cancer Center, 1007 Shimonagakubo Nagaizumi-cho, Sunto-gun, Shizuoka, Japan

    Tatsunori Satoh, Hirotoshi Ishiwatari, Hiroyuki Matsubayashi, Junichi Kaneko, Junya Sato, Kazuma Ishikawa & Hiroyuki Ono

  2. Department of Gastroenterology, Shizuoka General Hospital, Shizuoka, Japan

    Shinya Kawaguchi, Naofumi Shirane, Takuya Otsu & Shuzo Terada

  3. Division of Genetic Medicine Promotion, Shizuoka Cancer Center, Shizuoka, Japan

    Hiroyuki Matsubayashi

  4. Department of Gastroenterological Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Masataka Kikuyama

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  1. Tatsunori Satoh
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Correspondence to Hirotoshi Ishiwatari.

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Disclosures

Drs. Tatsunori Satoh, Hirotoshi Ishiwatari, Shinya Kawaguchi, Naofumi Shirane, Hiroyuki Matsubayashi, Junichi Kaneko, Junya Sato, Kazuma Ishikawa, Takuya Otsu, Shuzo Terada, Hiroyuki Ono, and Masataka Kikuyama have no conflicts of interest or financial ties to declare.

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Supplementary file1 (DOCX 19 KB)

464_2021_8342_MOESM2_ESM.tif

Supplementary file2 (TIF 252 KB) Supplementary Fig. 1 Kaplan–Meier curve comparing the cumulative time to recurrent biliary obstruction (TRBO) between UMS-14 and Niti-S SUPREMO. The TRBO for UMS-14 was significantly longer than that for Niti-S SUPREMO (not reached vs. 260 days, p = 0.02, log-rank test).

464_2021_8342_MOESM3_ESM.tif

Supplementary file3 (TIF 267 KB) Supplementary Fig. 2 Kaplan–Meier curve comparing the cumulative patient survival between UMS-14 and Niti-S SUPREMO. There are no significant differences in the patient survival between the two (169 days vs. 167 days, p = 0.88, log-rank test).

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Satoh, T., Ishiwatari, H., Kawaguchi, S. et al. Comparing the 14-mm uncovered and 10-mm covered metal stents in patients with distal biliary obstruction caused by unresectable pancreatic cancer: a multicenter retrospective study. Surg Endosc 36, 736–744 (2022). https://doi.org/10.1007/s00464-021-08342-z

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