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Endoscopic Stents for Palliation in Patients with Pancreatic Cancer

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Pancreatic Cancer

Abstract

Pancreatic carcinoma is a common, biologically aggressive malignancy that has a very poor prognosis. Management requires a multidisciplinary approach, with input from the subspecialties of surgery, gastrointestinal endoscopy, oncology, radiology, and radiation oncology. The only potentially curative form of treatment is surgical resection, although most patients present late in the course, with unresectable disease. Approximately 20% of patients presenting with malignant obstructive jaundice undergo some form of surgery (either resection or palliative bypass). The remaining 80% are managed nonsurgically. For this group of patients, who either have unresectable disease, refuse surgery, or are medically unfit for surgery, endoscopic palliation of symptoms should be strongly considered. Indeed, over the last decade, endoscopic palliation of malignant biliary obstruction has become an acceptable, and preferred, alternative to surgical bilioenteric bypass; this is achieved by the endoscopic placement of either plastic or metallic endoprostheses (stents).

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References

  1. Cotton PB. Endoscopic methods for relief of malignant obstructive jaundice. World J Surg 1984;8:854–861.

    Google Scholar 

  2. Huibregtse K, Katon RM, Coene PP, and Tytgat GNJ. Endoscopic palliative treatment in pancreatic cancer. Gastrointest Endosc 1986; 32:334–338.

    Article  PubMed  CAS  Google Scholar 

  3. Siegel JH and Snady H. The significance of endoscopically placed prostheses in the management of biliary obstruction due to carcinoma of the pancreas: results of nonoperative decompression in 277 patients. Am J Gastroenterol 1986; 81:634–641.

    PubMed  CAS  Google Scholar 

  4. Brandabur JJ, Kozarek RA, Ball TJ, Hofer BO, Ryan JA, Traverso LW, Freeny PC, and Lewis GP. Nonoperative versus operative treatment of obstructive jaundice in pancreatic cancer: cost and survival analysis. Am J Gastroenterol 1988; 83:1132–1139.

    PubMed  CAS  Google Scholar 

  5. Sheperd HA, Royle G, Ross APR, Diba A, Arthur M, and Colin-Jones D. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct—a randomized trial. Br J Surg 1988; 75:1166–1168.

    Article  Google Scholar 

  6. Deviere J, Baize M, DeToeuf J, and Cremer M. Long-term follow-up of patients with hilar malignant stricture treated by endoscopic internal biliary drainage. Gastrointest Endosc 1988; 34:95–101.

    Article  PubMed  CAS  Google Scholar 

  7. Andersen JR, Sorensen SM, Kruse A, Rokkjaer M, and Matzen P. Randomized trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 1989; 30:1132–1135.

    Article  PubMed  CAS  Google Scholar 

  8. Dowsett JF, Russell RCG, Hatfield ARW, Cotton PB, Speer AG, Houghton J, et al. Malignant obstructive jaundice: What is the best management? A prospective randomized trial of surgery vs endoscopic stenting. Gut 1989; 30:128.

    Article  Google Scholar 

  9. Cullingford GL, Srinivasan R, and Carr-Locke DL. Endoscopic endoprosthesis for malignant biliary obstruction. Gut 1989; 30:A1458.

    Google Scholar 

  10. Mizuma Y, Ikeda E, Mukai H, Yasuda K, and Nakajima M. ERBD vs PTBD in the management of inoperable malignant obstructive jaundice. Gastroenterol 1992; 102:A323.

    Google Scholar 

  11. Boender J, Nix GA, Schutte HE, Lameris JS, van Blankenstein M, and Dees J. Malignant common bile duct obstruction: factors influencing the success rate of endoscopic drainage. Endoscopy 1992; 22:259-262.

    Google Scholar 

  12. Marsh WH and Cunningham JT. Endoscopic stent placement for obstructive jaundice secondary to metastatic malignancy. Am J Gastroenterol 1992; 87:985–990.

    PubMed  CAS  Google Scholar 

  13. Motte S, Deviere J, Dumonceau J-M, Serruys E, Thys J-P, and Cremer M. Risk factors for septicemia following endoscopic biliary stenting. Gastroenterology 1991; 101:1374–1381.

    PubMed  CAS  Google Scholar 

  14. Frakes JT, Johanson JF, and Stake JJ. Optimal timing for stent replacement in malignant biliary tract obstruction. Gastrointest Endosc 1993; 39:164–167.

    Article  PubMed  CAS  Google Scholar 

  15. Ferrari AP, Lichtenstein DR, Slivka A, Chang C, and Carr-Locke DL. Brush cytology during ERCP for the diagnosis of biliary and pancreatic malignancies. Gastrointest Endosc 1994; 40:140–145.

    Article  Google Scholar 

  16. Foutch PG, Kerr DM, Harlan JR, Manne RK, Kummet TD, and Sanowski RA. Endoscopic retrograde wire-guided brush cytology for diagnosis of patients with malignant obstruction of the bile duct. Am J Gastroenterol 1990; 85:791–795.

    PubMed  CAS  Google Scholar 

  17. Venu RP, Geenen JE, Kini M, Hogan WJ, Payne M, Johnson GK, and Schmalz MJ. Endoscopic retrograde brush cytology: a new technique. Gastroenterology 1990; 99:475–479.

    Google Scholar 

  18. Kubota Y, Takaoka M, and Tani K. Endoscopic transpapillary biopsy for diagnosis of patients with pancreaticobiliary ductal strictures. Am J Gastroenterol 1993; 88:1700–1704.

    PubMed  CAS  Google Scholar 

  19. Howell DA, Beveridge RP, Bosco J, and Jones M. Endoscopic needle aspiration biopsy at ERCP in the diagnosis of biliary strictures. Gastrointest Endosc 1992; 38:531–535.

    Article  PubMed  CAS  Google Scholar 

  20. Kadakia SC and Starnes E. Comparison of 10 French gauge stent with 11.5 French gauge stent in patients with biliary tract diseases. Gastrointest Endosc 1992; 38:454–459.

    Article  PubMed  CAS  Google Scholar 

  21. Slivka A. Directed guide wire placement during ERCP using a papillotome. Gastrointest Endosc 1996; 44:187–189.

    Article  PubMed  CAS  Google Scholar 

  22. Leung JWC, Ling TKW, Kung JLS, and Vallance-Owen J. The role of bacteria in the blockage of biliary stents. Gastrointest Endosc 1988; 34:19–22.

    Article  PubMed  CAS  Google Scholar 

  23. Huibregtse K. Endoscopic biliary and pancreatic drainage, Georg Thieme Vertag, Stuttgart, 1988.

    Google Scholar 

  24. Speer AG, Cotton PB, Rhode J, Seddon AM, Neal CR, Holton J, and Costerton JW. Biliary stent blockage with bacterial biofilm. Ann Intern Med 1988; 108:546–553.

    PubMed  CAS  Google Scholar 

  25. Speer AG, Cotton PB, and MacRae KD. Endoscopic management of malignant biliary obstruction: stents of 10 French gauge are preferable to stents of 8 French gauge. Gastrointest Endosc 1988; 34:412–417.

    Article  PubMed  CAS  Google Scholar 

  26. Coene PPLO. Endoscopic biliary stenting: Mechanisms and possible solutions of the clogging phenomenon. MD Thesis. CIP-DATA Koninklijke Bibliotheek den Haag, 1990.

    Google Scholar 

  27. Sung JY, Shaffer EA, Lam K, and Costerton JW. Inhibition of E. coli adhesion on biliary stents by bile salts with different hydrobicites. Gastrointest Endosc 1992; 38:263.

    Google Scholar 

  28. Hurwich DB, Poterucha JJ, Nixon DE, Cockerill FR, Moyer TP, and Thistle JL. Preventing biliary stent occlusion. Gastrointest Endosc 1992; 38:268.

    Google Scholar 

  29. Seitz U, Vadeyar H, and Soehendra N. Prolonged patency with a new-design Teflon biliary prosthesis. Endoscopy 1994; 26:478–482.

    Article  PubMed  CAS  Google Scholar 

  30. Johanson JF and Frakes JT. Optimal timing for stent replacement in malignant biliary strictures. Gastrointest Endosc 1992; 38:254.

    Google Scholar 

  31. Cessot F, Sauterau D, Le Sidaner A, Moesch C, Berry P, Florence J, Deviois B, and Pille-gand B. Obstruction delay of biliary endoprostheses. Gastroenterol 1992; 102:A304.

    Google Scholar 

  32. Soehendra N. A new method for exchanging biliary stents. Endoscopy 1990; 22:271-272.

    Google Scholar 

  33. Knyrim K, Wagner HJ, Pausch J, and Vakil N. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 1993; 25:207–212.

    Article  PubMed  CAS  Google Scholar 

  34. Tarnasky PR, Morris J, Hawes RH, Hoffman BJ, Cotton PB, and Cunningham JT. Snare beside-a-wire biliary stent exchange: a method that maintains access across biliary strictures. Gastrointest Endosc 1996; 44:185–187.

    Article  PubMed  CAS  Google Scholar 

  35. Yoshioka T, Sakaguchi H, Yoshimura H, Tamada T, Ohishi H, Uchida H, and Wallace S. Expandable metallic biliary endoprostheses: preliminary clinical evaluation. Radiology 1990; 177:253–257.

    PubMed  CAS  Google Scholar 

  36. Lammer J. Biliary endoprosthesis, plastic versus metal stents. Radiol Clin North Am 1990; 28:1211–1222.

    PubMed  CAS  Google Scholar 

  37. Kozarek RA, Ball TJ, and Patterson DJ. Metallic self-expanding stent application in the upper gastrointestinal tract: caveats and concerns. Gastrointest Endosc 1992; 38:1–6.

    Article  PubMed  CAS  Google Scholar 

  38. Salomonowitz EK, Antonucci F, Heer M, Stuckmann G, Egloff B, and Zollikofer CL. Biliary obstruction: treatment with self-expanding metal prostheses. J Vasc Interv Radiol 1992; 3:365–370.

    Article  PubMed  CAS  Google Scholar 

  39. Jackson JE, Roddie ME, Chetty N, Benjamin IS, and Adam A. The management of occluded metallic self-expandable biliary endoprostheses. Am J Roentgenol 1991; 157:291–292.

    CAS  Google Scholar 

  40. Shim CS, Lee MS, Kim JH, and Cho SW. Endoscopic application of Gianturco-Rosch biliary Z-stent. Endoscopy 1992; 24:436–439.

    Article  PubMed  CAS  Google Scholar 

  41. Neuhaus H, Hagenmuller F, and Classen M. Self-expanding biliary stents, preliminary clinical experience. Endoscopy 1989; 21:225–228.

    Article  PubMed  CAS  Google Scholar 

  42. Nicholson DA, Chetty N, Jackson JE, Roddie ME, and Adam A. Patency of side branches after peripheral placement of metallic biliary endoprostheses. J Vasc Interv Radiol 1992; 3:127–130.

    Article  PubMed  CAS  Google Scholar 

  43. Kawase Y, Takemura T, and Hashimoto T. Endoscopic implantation of expandable metal Z stents for malignant biliary strictures. Gastrointest Endosc 1993; 39:65–67.

    Article  PubMed  CAS  Google Scholar 

  44. Bethge N, Wagner HJ, Knyrim K, Zimmerman HB, Starck E, Pausch J, and Vakil N. Technical failure of biliary metal stent deployment in a series of 116 applications. Endoscopy 1992; 24:395–400.

    Article  PubMed  CAS  Google Scholar 

  45. Huibregtse K, Carr-Locke DL, Cremer M, Domschke W, Fockens P, Foerster E, et al. Biliary stent occlusion: a problem solved with self-expanding metal stents? Endoscopy 1992; 24:391–394.

    Article  PubMed  CAS  Google Scholar 

  46. Cotton PB. Metallic mesh stents: Is the expanse worth the expense? Endoscopy 1992; 24:421–423.

    Article  PubMed  CAS  Google Scholar 

  47. Carr-Locke DL, Ball TJ, Connors PJ, Cotton PB, Geenen JE, Hawes RH, et al. Multicenter randomized trial of Wallstent biliary endoprosthesis versus plastic stents. Gastrointest Endosc 1993; 39: A310.

    Google Scholar 

  48. Davids PHP, Groen AK, Rauws EAJ, Tytgat GNJ, and Huibregtse K. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340:1488–1492.

    Article  PubMed  CAS  Google Scholar 

  49. Cremer M, Deviere J, Sugai B, and Baize M. Expandable biliary metal stents for malignancies: endoscopic insertion and diathermic cleaning for tumor ingrowth. Gastrointest Endosc 1990; 36:451–457.

    Article  PubMed  CAS  Google Scholar 

  50. Dertinger S, Ell C, Fleig WE, Hóchberger J, Karn M, Gurza L, and Hahn EG. Long-term results using self-expanding metal stents for malignant biliary obstruction. Gastroenterol 1992;102:A310.

    Google Scholar 

  51. Sievert CE, Silvis SE, Vennes JA, Abeyta B, and Brennecke LH. Comparison of covered vs uncovered wire stents in the canine biliary tract. Gastrointest Endosc 1992; 38:A262.

    Google Scholar 

  52. Goldin E, Wengrower D, Fich A, Safra T, Verstandig A, Globerman O, and Beyar M. A new self-expandable and removable metal stent for biliary obstruction. Gastrointest Endosc 1992;38:A251.

    Google Scholar 

  53. Bethge N, Sommer A, Gross U, von Kleist D, and Vakil N. Human tissue responses to metal stents implanted in vivo for the palliation of malignant stenoses. Gastrointest Endosc 1996; 43:596–602.

    Article  PubMed  CAS  Google Scholar 

  54. Leung JWC, Chung SCS, Sung JY, and Li MKW. Acute cholecystitis after stenting of the common bile duct for obstruction secondary to pancreatic cancer. Gastrointest Endosc 1989; 35:109–110.

    Article  PubMed  CAS  Google Scholar 

  55. Gould J, Train JS, Dan SJ, and Mitty HA. Duodenal perforation as a delayed complication of placement of a biliary endoprosthesis. Radiology 1988; 167:467–469.

    PubMed  CAS  Google Scholar 

  56. Johanson JF, Schmaltz MJ, and Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38:341–346.

    Article  PubMed  CAS  Google Scholar 

  57. Matsuda Y, Shimakura K, and Akamatsu T. Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. Am J Gastroenterol 1991; 86:843–849.

    PubMed  CAS  Google Scholar 

  58. Mallat A, Saint-Marc Girardin MF, Meduri B, Liguory C, and Dhumeaux D. Fracture of biliary endoprosthesis after endoscopic drainage for malignant biliary obstruction. Report of two cases. Endoscopy 1986; 18:243–244.

    CAS  Google Scholar 

  59. ASGE Report. Antibiotic prophylaxis for gastrointestinal endoscopy. Gastrointest Endosc 1995;42:630–635.

    Article  Google Scholar 

  60. Vandervoort J, Tham TCK, Wong RCK, Lichtenstein DR, Van Dam J, Ruymann F, Hughes M, and Carr-Locke DL. Is there a need for prophylactic antibiotics prior to ERCP for suspected bile duct obstruction? Gastrointest Endosc 1996; 43:323.

    Article  Google Scholar 

  61. Hall RI, Denyer ME, and Chapman AH. Palliation of obstructive jaundice with a biliary endoprosthesis. Comparison of insertion by the percutaneous-transhepatic and the combined percutaneous-endoscopic routes. Interv Radiol 1989; 40:186–189.

    CAS  Google Scholar 

  62. Tarnasky PR, Cotton PB, Baillie J, Branch MS, Affronti J, Jowell P, et al. Proximal migration of biliary stents: attempted endoscopic retrieval in forty-one patients. Gastrointest Endosc 1995; 42:513–519.

    Article  PubMed  CAS  Google Scholar 

  63. Martin DF. Wire guided balloon assisted endoscopic biliary stent exchange. Gut 1991; 32:1562–1564.

    Article  PubMed  CAS  Google Scholar 

  64. Sherman S, Hawes RH, Uzer MF, Smith MT, and Lehman GA. Endoscopic stent exchange using a guide wire and mini-snare. Gastrointest Endosc 1993; 39:794–799.

    Article  PubMed  CAS  Google Scholar 

  65. Soehendra N, Maydeo A, Eckmann B, Bruckner M, Nam VC, and Grimm H. A new technique for replacing an obstructed biliary endoprosthesis. Endoscopy 1990; 22:271–272.

    Article  PubMed  CAS  Google Scholar 

  66. Tham TCK, Vandervoort J, Wong RCK, Carr-Locke DL, Chow S, Bosco JJ, et al. Management of occluded biliary Wallstents. Gastrointest Endosc 1996; 43:400.

    Google Scholar 

  67. Costamagna G, Gabbrielle A, Mutignani M, Perri V, and Crucitti F. Treatment of obstructive pain by endoscopic drainage in patients with pancreatic head carcinoma. Gastrointest Endosc 1993; 39:774–777.

    Article  PubMed  CAS  Google Scholar 

  68. Sarr MG, Gladen HE, Beart RW, Jr., and van Heerden JA. Role of gastroenterostomy in patients with unresectable carcinoma of the pancreas. Surg Gyn Obstet 1981; 152:597–600.

    CAS  Google Scholar 

  69. Weaver DW, Wiencek RG, Bouwman DL, and Walt AJ. Gastrojejunostomy: Is it helpful for patients with pancreatic cancer? Surgery 1987; 102:608–613.

    PubMed  CAS  Google Scholar 

  70. Kozarek RA, Ball TJ, and Patterson DJ. Metallic self-expanding stent application in the upper gastrointestinal tract: caveats and concerns. Gastrointest Endosc 1992; 38:1–6.

    Article  PubMed  CAS  Google Scholar 

  71. Keymling M, Wagner H-J, Vakil N, and Knyrim K. Relief of malignant duodenal obstruction by percutaneous insertion of a metal stent. Gastrointest Endosc 1993; 39:439–441.

    Article  PubMed  CAS  Google Scholar 

  72. Feretis C, Benakis P, Dimopoulos C, Georgopoulos K, Milas F, Manouras A, and Apostolidis N. Palliation of malignant gastric outlet obstruction with self-expanding metal stents. Endoscopy 1996; 28:225–228.

    Article  PubMed  CAS  Google Scholar 

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Wong, R.C.K., Carr-Locke, D.L. (1998). Endoscopic Stents for Palliation in Patients with Pancreatic Cancer. In: Reber, H.A. (eds) Pancreatic Cancer. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-1810-4_13

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  • DOI: https://doi.org/10.1007/978-1-4612-1810-4_13

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-4612-7294-6

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