Predictors of stent occlusion in patients with unresectable pancreatic cancer after biliary metal stents. Issue 10 (October 2019)

• Record Type: Journal Article
• Authors: Lin, Xi-Hsuan; Ting, Po-Hsiang; Luo, Jiing-Chyuan; Lee, Kuei-Chuan; Chen, Tseng-Shing; Huang, Yi-Hsiang; Hou, Ming-Chih; Lee, Fa-Yauh
• Is Part Of: Journal of the Chinese Medical Association. Volume 82:Issue 10(2019)
• Publication Date: 2019-10
• Subjects: Malignant biliary obstruction -- Pancreatic cancer -- Partially covered self-expandable metal stent -- Stent occlusion; Medicine -- Periodicals; 610.5
• DOI: 10.1097/JCMA.0000000000000162
• Languages: English
• ISSNs: 1726-4901

Abstract

Abstract : Background: Self-expandable metal stents (SEMS) are a widely accepted biliary endoprosthesis for patients with unresectable malignant biliary obstruction. Here, we identified predictors for the occlusion of SEMS in unresectable pancreatic cancer patients with biliary tract obstruction. Methods: Patients with a distal malignant biliary obstruction caused by unresectable pancreatic cancer who received partially covered SEMS (PC-SEMS) placement for the first time between January 2003 and January 2016 were retrospectively enrolled for analysis. The rates of PC-SEMS occlusion were evaluated. The possible predictors of PC-SEMS occlusion were analyzed using Cox regression analysis. Results: In total, 120 patients who received PC-SEMS for unresectable pancreatic cancer were identified. The rate of PC-SEMS occlusion was 37%. The median time to occlusion of PC-SEMS was 359 days. The major causes of occlusion included biliary sludge (61%) and tumor ingrowth (30%). Cox multivariate regression analysis revealed that inadequate alkaline phosphatase/gamma-glutamyl transferase decline (defined by a decrease of <50% within 2 wk after PC-SEMS placement) was the only independent predictor of stent occlusion (hazard ratio, 2.86; 95% CI, 1.28-6.25; p = 0.01) Conclusion: Inadequate alkaline phosphatase/gamma-glutamyl transferase decline is a predictor of occlusion of first-time PC-SEMS placement in unresectable pancreatic cancer patients with biliary tract obstruction.