Self-expandable metallic stents for malignant biliary obstruction with an anomalous pancreaticobiliary junction.
BACKGROUND
Anomalous pancreaticobiliary junction (APBJ) is associated with pancreaticobiliary cancer. Limited data are available on endoscopic biliary drainage for unresectable malignant biliary obstruction with APBJ. This study evaluated the efficacy and safety of self-expandable metallic stents (EMSs) for the management of malignant biliary obstruction with APBJ.


METHODS
Between 1993 and 2005, 324 patients with unresectable malignant biliary obstruction underwent insertion of an EMS. Six of these patients with concomitant APBJ constituted the subjects of this study. Early (</=30 days after EMS insertion) and late (>30 days after EMS insertion) stent-related complications and stent patency were evaluated in these six patients.


RESULTS
The cause of biliary obstruction was gallbladder cancer in four patients and pancreatic cancer in two patients. Uncovered EMSs were inserted across the common channel without performance of a biliary sphincterotomy. The diameter of the uncovered EMS used was based on the diameter of the common channel. For all six patients, endoscopic biliary drainage was successful, and their jaundice subsided steadily. None of the six patients experienced early complications, including acute pancreatitis. The mean stent-related complication-free period was 163 days. Stent occlusion caused by tumor ingrowth occurred in two patients. Acute cholangitis and cholecystitis were observed in one patient each.


CONCLUSIONS
Uncovered EMSs are effective for palliation of unresectable malignant biliary obstruction in patients who have APBJ without increasing the risk of stent-related early complications.
Kogure
H
H
Department of Gastroenterology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. kogureh-tky@umin.ac.jp
Tsujino
T
T
Yagioka
H
H
Sasaki
T
T
Nakai
Y
Y
Hirano
K
K
Sasahira
N
N
Isayama
H
H
Tada
M
M
Kawabe
T
T
Omata
M
M
D000368:Aged; D000369:Aged, 80 and over; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation / Q000379:methods*; D002779:Cholestasis / Q000209:etiology* / Q000628:therapy*; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome
Gastrointest Endosc. 2005 Nov;62(5):742-8
16246690
Gastrointest Endosc. 2005 Apr;61(4):528-33
15812404
Gut. 1989 Aug;30(8):1132-5
2475392
Gastrointest Endosc. 1999 Nov;50(5):623-7
10536316
Lancet. 1992 Dec 19-26;340(8834-8835):1488-92
1281903
Int Surg. 1995 Jul-Sep;80(3):215-7
8775605
Gut. 2004 May;53(5):729-34
15082593
Am J Gastroenterol. 1987 Jan;82(1):20-4
3799576
Gastrointest Endosc. 2003 Feb;57(2):178-82
12556780
J Hepatobiliary Pancreat Surg. 2000;7(6):551-5
11180886
Br J Surg. 1993 May;80(5):622-4
8518907
Cancer. 1979 Sep;44(3):1134-41
383269
Hepatogastroenterology. 2001 Nov-Dec;48(42):1767-9
11813620
Gastrointest Endosc. 2006 Oct;64(4):522-9
16996343
Clin Gastroenterol Hepatol. 2006 Sep;4(9):1148-53
16904950
Gastroenterology. 1985 Dec;89(6):1258-65
4054518
Lancet. 1994 Dec 17;344(8938):1655-60
7996958
Gastrointest Endosc. 2002 Mar;55(3):366-70
11868010
Gastrointest Endosc. 2003 Apr;57(4):541-5
12665766
Hepatogastroenterology. 2001 Mar-Apr;48(38):382-6
11379314
Gastrointest Endosc. 1991 May-Jun;37(3):383-93
2070995
Int Surg. 1995 Jan-Mar;80(1):61-4
7657495
Hepatogastroenterology. 1998 Nov-Dec;45(24):2016-9
9951856
J Hepatobiliary Pancreat Surg. 1999;6(3):218-22
10526055
Gastrointest Endosc. 1998 Aug;48(2):184-9
9717785
J Hepatobiliary Pancreat Surg. 1998;5(1):113-6
9683764
J Hepatobiliary Pancreat Surg. 2002;9(1):45-54
12021897