title: Sequential or simultaneous placement of self-expandable metallic stents for palliation of malignant biliary and duodenal obstruction due to unresectable pancreatic head carcinoma.
abstract: BACKGROUND
  Pancreatic cancer is generally not amenable to curative resection, and self-expanding metallic stents have been used to relieve obstruction of bile duct and duodenum in patients with unresectable pancreatic cancer. However, both relative experience with sequential or simultaneous endoscopic stents placement in biliary and duodenal stricture and long-term efficacy of these stents are limited. The aim of this study was to present our experience on the effectiveness of this form of endoscopic treatment.
  
  
  METHODS
  We performed a retrospective review of all patients undergoing sequential or simultaneous biliary and duodenal stent placement for biliary and symptomatic duodenal obstruction due to unresectable pancreatic head carcinomas in 4 tertiary endoscopic centers. Data were collected from endoscopy and outpatient clinic reports, x-rays, and telephone calls. All patients were followed until their death. Endpoints included technical and clinical success, stent long-term patency, and survival.
  
  
  RESULTS
  Thirty-nine patients with unresectable pancreatic head cancer were included. Biliary or duodenal stenting was unsuccessful in 7 patients (17.9%). The remaining 32 patients (median age: 77 y; range: 52 to 82 y), with locally advanced (n=21) or metastatic disease (n=11), were studied. Twenty-one patients (65.6%) received at least first-line chemotherapy. Overall median survival was 9 months (range: 2 to 22 mo), being higher in locally advanced (median survival: 11.5 mo, range: 4 to 22 mo) than metastatic disease (median survival: 3 mo, range: 2 to 5.5 mo) (P<0.001). Median duodenal and biliary patency was 3 months (range: 1 to 12 mo) and 9 months (range: 2 to 22 mo), respectively (P<0.05). Nine of 32 patients (28.1%) required reintervention for recurrent symptoms. No major complications or death occurred in relation to endoscopic treatment.
  
  
  CONCLUSIONS
  Placement of self-expandable metal stents is a safe and efficacious palliation method for biliary and duodenal obstruction due to unresectable pancreatic head carcinoma. The majority of patients do not require reintervention and those who require can usually be managed nonoperatively.
authors.affiliation: Department of Endoscopy and Motility Unit, Central Hospital, Aristotle University of Thessaloniki, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Katsinelos
authors.forename: Jannis
authors.initials: J
authors.lastname: Kountouras
authors.forename: George
authors.initials: G
authors.lastname: Germanidis
authors.forename: George
authors.initials: G
authors.lastname: Paroutoglou
authors.forename: Dimitris
authors.initials: D
authors.lastname: Paikos
authors.forename: Georgia
authors.initials: G
authors.lastname: Lazaraki
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pilpilidis
authors.forename: Grigoris
authors.initials: G
authors.lastname: Chatzimavroudis
authors.forename: Kostas
authors.initials: K
authors.lastname: Fasoulas
authors.forename: Christos
authors.initials: C
authors.lastname: Zavos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002404:Catheterization; D002760:Cholangiopancreatography, Endoscopic Retrograde; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D004380:Duodenal Obstruction / Q000209:etiology / Q000628:therapy*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome