title: Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas.
abstract: BACKGROUND
  Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown.
  
  
  OBJECTIVE
  To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer.
  
  
  METHODS
  All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival.
  
  
  RESULTS
  One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment.
  
  
  CONCLUSIONS
  Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.
authors.affiliation: Pôle des Maladies de l'Appareil Digestif, Hôpital Beaujon, AP-HP, Clichy, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Maire
authors.forename: Pascal
authors.initials: P
authors.lastname: Hammel
authors.forename: Philippe
authors.initials: P
authors.lastname: Ponsot
authors.forename: Alain
authors.initials: A
authors.lastname: Aubert
authors.forename: Dermot
authors.initials: D
authors.lastname: O'Toole
authors.forename: Olivia
authors.initials: O
authors.lastname: Hentic
authors.forename: Philippe
authors.initials: P
authors.lastname: Levy
authors.forename: Philippe
authors.initials: P
authors.lastname: Ruszniewski
mesh_terms: D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001659:Biliary Tract; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D003137:Common Bile Duct Diseases / Q000209:etiology / Q000628:therapy; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy*; D004386:Duodenum; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality / Q000628:therapy; D015607:Stents; D015996:Survival Rate