title: Clinical significance of portal venous metallic stent placement in recurrent periampullary cancers.
abstract: 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.
authors.affiliation: Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan. yamazaki-nmed@umin.ac.jp
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Kenmei
authors.initials: K
authors.lastname: Kuramoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Itoh
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Norio
authors.initials: N
authors.lastname: Susa
authors.forename: Toshisada
authors.initials: T
authors.lastname: Ueda
mesh_terms: 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