Clinical significance of portal venous metallic stent placement in recurrent periampullary cancers.
OBJECTIVE
We evaluate the clinical significance of portal venous expandable metallic stent (EMS) placement for patients who have malignant portal hypertension caused by recurrent periampullary cancer.


METHODS
Four post-pancreatoduodenectomy patients underwent percutaneous transhepatic portal venous EMS placement because of symptoms of malignant portal hypertension: intractable ascites (2/4), growth of abnormal collateral vein (3/4), melena (2/4), gastroesophageal varix (3/4) and thrombocytopenia (2/4). They were diagnosed with having a recurrence by cytology of ascitis, computed tomography and/or tumor markers in serum. The stenosis segment was measured by percutaneous-transhepatic portography and was dilated with a balloon prestent placement. The patency of stent was confirmed using Doppler ultrasonography and enhanced computed tomography at least once a month.


RESULTS
The portal venous pressure was significantly decreased from (24.5 +/- 3.92 mmH2O) to (19.5 +/- 3.87 mmH2O) and the symptoms related to portal hypertension were reduced in all patients. There were no complications related to EMS placement. All patients were alive more than a year later and two of four patients were alive more than two years without morbidity.


CONCLUSIONS
Percutaneous-transhepatic portal EMS placement is a minimally invasive procedure and is a useful treatment against malignant portal hypertension caused by recurrent periampullary cancer.
Yamazaki
Shintaro
S
Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. yamazaki-nmed@umin.ac.jp
Kuramoto
Kenmei
K
Itoh
Yutaka
Y
Watanabe
Yoshika
Y
Susa
Norio
N
Ueda
Toshisada
T
D000368:Aged; D000800:Angioplasty, Balloon; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000401:mortality; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality; D011169:Portal Vein / Q000601:surgery; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome