PMID- 33140016
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20201104
IS  - 2364-3722 (Print)
IS  - 2196-9736 (Electronic)
IS  - 2196-9736 (Linking)
VI  - 8
IP  - 11
DP  - 2020 Nov
TI  - Novel risk factors for recurrent biliary obstruction and pancreatitis after 
      metallic stent placement in pancreatic cancer.
PG  - E1603-E1610
LID - 10.1055/a-1244-1989 [doi]
AB  - Background and study aims  Self-expandable metallic stents (SEMS) are now widely 
      used even for patients with borderline resectable (BR) pancreatic cancer (PC), as 
      neoadjuvant therapy has become common. Therefore, we conducted this study to 
      evaluate safety of SEMS placement in the population including BR PC and to 
      explore risk factors for recurrent biliary obstruction (RBO), pancreatitis, and 
      cholecystitis. Patients and methods  We retrospectively investigated consecutive 
      patients with PC who received initial SEMS between January 2015 and March 2019. 
      We compared time to RBO (TRBO), causes of RBO, and stent-related adverse events 
      (AEs) according to resectability status. Univariate and multivariate analyses 
      were performed to explore risk factors for TRBO, pancreatitis, and cholecystitis. 
      Results  A total of 135 patients were included (BR 31 and unresectable [UR] 104). 
      Stent-related AEs occurred in 39 patients: pancreatitis 14 (mild/moderate/severe 
      1/6/7), cholecystitis 12, and non-occluding cholangitis 13. TRBO, causes of RBO, 
      and stent-related AEs were not significantly different according to resectability 
      status. Overall rate of RBO was higher in UR PC due to the longer follow-up 
      period. Sharp common bile duct (CBD) angulation was an independent risk factor 
      for short duration of TRBO. High pancreatic volume index and SEMS of high axial 
      force were independent risk factors for pancreatitis, whereas tumor involvement 
      to orifice of cystic duct was the only risk factor for cholecystitis. 
      Conclusions  We demonstrated that SEMS can be safely deployed even in patients 
      with BR PC. Sharp CBD angulation and high pancreatic volume index were identified 
      as novel risk factors for RBO and pancreatitis, respectively, after SEMS 
      placement.
CI  - The Author(s). This is an open access article published by Thieme under the terms 
      of the Creative Commons Attribution-NonDerivative-NonCommercial License, 
      permitting copying and reproduction so long as the original work is given 
      appropriate credit. Contents may not be used for commecial purposes, or adapted, 
      remixed, transformed or built upon. 
      (https://creativecommons.org/licenses/by-nc-nd/4.0/).
FAU - Takeda, Tsuyoshi
AU  - Takeda T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Sasaki, Takashi
AU  - Sasaki T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Mie, Takafumi
AU  - Mie T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Furukawa, Takaaki
AU  - Furukawa T
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Kanata, Ryo
AU  - Kanata R
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Kasuga, Akiyoshi
AU  - Kasuga A
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Matsuyama, Masato
AU  - Matsuyama M
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Ozaka, Masato
AU  - Ozaka M
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
FAU - Sasahira, Naoki
AU  - Sasahira N
AD  - Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of 
      Japanese Foundation for Cancer Research, Tokyo, Japan.
LA  - eng
PT  - Journal Article
DEP - 20201022
PL  - Germany
TA  - Endosc Int Open
JT  - Endoscopy international open
JID - 101639919
PMC - PMC7581474
COIS- Competing interests Dr. Sasahira has received honoraria from Boston Scientific 
      Japan and Cook Medical Japan. Dr. Sasaki has received honoraria from Boston 
      Scientific Japan, Cook Medical Japan, and Century Medical Inc.
EDAT- 2020/11/04 06:00
MHDA- 2020/11/04 06:01
PMCR- 2020/11/01
CRDT- 2020/11/03 05:47
PHST- 2020/04/28 00:00 [received]
PHST- 2020/08/03 00:00 [accepted]
PHST- 2020/11/03 05:47 [entrez]
PHST- 2020/11/04 06:00 [pubmed]
PHST- 2020/11/04 06:01 [medline]
PHST- 2020/11/01 00:00 [pmc-release]
AID - 10.1055/a-1244-1989 [doi]
PST - ppublish
SO  - Endosc Int Open. 2020 Nov;8(11):E1603-E1610. doi: 10.1055/a-1244-1989. Epub 2020 
      Oct 22.