title: Plastic biliary stent patency in patients with locally advanced pancreatic adenocarcinoma receiving downstaging chemotherapy.
abstract: BACKGROUND
  Plastic stents in patients with biliary obstruction caused by pancreatic adenocarcinoma are typically exchanged at 3-month intervals. Plastic stents may have reduced durability in patients receiving chemotherapy.
  
  
  OBJECTIVE
  To determine the duration of plastic biliary stent patency in patients undergoing chemotherapy for pancreatic adenocarcinoma.
  
  
  METHODS
  Retrospective, multicenter cohort study.
  
  
  METHODS
  Three tertiary academic referral centers.
  
  
  METHODS
  A total of 173 patients receiving downstaging chemotherapy for locally advanced or borderline resectable pancreatic adenocarcinoma from 1996 to 2013.
  
  
  METHODS
  Placement of 10F or larger plastic biliary stents.
  
  
  METHODS
  Primary outcome was overall duration of stent patency. Secondary outcomes included the incidence of premature stent exchange (because of cholangitis or jaundice) and hospitalization rates.
  
  
  RESULTS
  A total of 233 plastic stents were placed, and the overall median duration of stent patency was 53 days (interquartile range [IQR] 25-99 days). Eighty-seven stents were removed at the time of surgical resection, and 63 stents were exchanged routinely per protocol. The remaining 83 stent exchanges were performed for worsening liver function test results, jaundice, or cholangitis, representing a 35.6% rate of premature stent exchange. The median stent patency duration in the premature stent exchange group was 49 days (IQR 25-91 days) with a 44.6% hospitalization rate. The overall rate of cholangitis was 15.0% of stent exchanges, occurring a median of 56 days after stent placement (IQR 26-89 days).
  
  
  CONCLUSIONS
  Retrospective study.
  
  
  CONCLUSIONS
  Plastic biliary stents placed during chemotherapy/chemoradiation for pancreatic adenocarcinoma have a shorter-than-expected patency duration, and a substantial number of patients will require premature stent exchange. Consideration should be given to shortening the interval for plastic biliary stent exchange.
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Phillip S
authors.initials: PS
authors.lastname: Ge
authors.affiliation: Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Hamerski
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Rabindra R
authors.initials: RR
authors.lastname: Watson
authors.affiliation: Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
authors.forename: Srinadh
authors.initials: S
authors.lastname: Komanduri
authors.affiliation: Department of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Birtukan B
authors.initials: BB
authors.lastname: Cinnor
authors.affiliation: Division of Gastroenterology, Northwestern Memorial Hospital, Chicago, Illinois, USA.
authors.forename: Kiran
authors.initials: K
authors.lastname: Bidari
authors.affiliation: Gastrointestinal Tumor Program, Section of Endoscopic Oncology, Moffitt Cancer Center, University of South Florida, Tampa, Florida, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Klapman
authors.affiliation: Gastrointestinal Tumor Program, Section of Endoscopic Oncology, Moffitt Cancer Center, University of South Florida, Tampa, Florida, USA.
authors.forename: Cui L
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Interventional Endoscopy Services, California Pacific Medical Center, San Francisco, California, USA.
authors.forename: Janak N
authors.initials: JN
authors.lastname: Shah
authors.affiliation: Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Wani
authors.affiliation: Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Donahue
authors.affiliation: Division of Digestive Diseases, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
authors.forename: V Raman
authors.initials: VR
authors.lastname: Muthusamy
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000628:therapy*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D004724:Endoscopy; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy*; D010969:Plastics; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D010969:Plastics