title: Fully covered self-expandable metal stents are effective and safe to treat distal malignant biliary strictures, irrespective of surgical resectability status.
abstract: OBJECTIVE
  We report a retrospective analysis of patients with malignant biliary obstruction in whom a newly released fully silicon-covered, WallFlex, self-expandable metal stent (CSEMS) was placed for biliary decompression.
  
  
  METHODS
  Between March, 2009 and March, 2010, all patients with obstructive jaundice secondary to pancreatic cancer underwent placement of a CSEMS, regardless of resectability. A CSEMS was placed across the malignant stricture. These patients were then staged for their cancer by computed tomography, magnetic resonance imaging, and/or endoscopic ultrasound-guided fine-needle aspiration. Patient found to have resectable cancer were offered a pancreaticoduodenectomy.
  
  
  RESULTS
  We identified 88 patients with pancreatic cancer who received a CSEMS. Forty patients were deemed resectable and underwent surgery. Pancreaticoduodenectomy was performed in 34 of 40 patients. The CSEMS was easily removed at the time of surgical resection without any complications. The 44 unresected patients with covered SEMS were followed for a mean of 4.2 months (range, 1 to 13). The patency rate for stents was 97% at 12 months. Immediate procedural complications included post-endoscopic retrograde cholangiopancreatography pancreatitis (n=9) and duodenal perforation (n=2). Four patients (5%) had migration and 3 (3%) had stent occlusion. There were no cases of cholecystitis during the follow-up. The patients who presented with stent migration or occlusion underwent stent revision.
  
  
  CONCLUSIONS
  Placement of the newly available CSEMS can be used to effectively and safely treat biliary obstructions from pancreatic carcinoma. We recommend that the CSEMS be used as an initial intervention to relieve malignant biliary obstruction, even in patients whose surgical resectability status is uncertain.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine Thomas Jefferson University Hospital, Philadelphia, PA, USA. ali.siddiqui@jefferson.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: Siddiqui
authors.forename: Vaibhav
authors.initials: V
authors.lastname: Mehendiratta
authors.forename: David
authors.initials: D
authors.lastname: Loren
authors.forename: Shih-Kuang
authors.initials: SK
authors.lastname: Hong
authors.forename: Thomas
authors.initials: T
authors.lastname: Kowalski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000556:secondary / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000379:methods; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D014057:Tomography, X-Ray Computed