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Latenstein, A.E.J.; Mackay, T.M.; Huijgevoort, N.C.M. van; Bonsing, B.A.; Bosscha, K.; Hol, L.; ... ; Dutch Pancreatic Canc Grp (2021)

Nationwide practice and outcomes of endoscopic biliary drainage in resectable pancreatic head and periampullary cancer

Article / Letter to editor
Background: Guidelines advise self-expanding metal stents (SEMS) over plastic stents in preoperative endoscopic biliary drainage (EBD) for malignant extrahepatic biliary obstruction. This study aims to assess nationwide practice and outcomes.Methods: Patients with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2017 & ndash;2018). Multi variable logistic and linear regression models were performed.Results: In total, 575/1056 patients (62.0%) underwent preoperative EBD: 246 SEMS (42.8%) and 329 plastic stents (57.2%). EBD-related complications were comparable between the groups (44/246 (17.9%) vs. 64/329 (19.5%), p = 0.607), including pancreatitis (22/246 (8.9%) vs. 25/329 (7.6%), p = 0.387). EBD-related cholangitis was reduced after SEMS placement (10/246 (4.1%) vs. 32/329 (9.7%), p = 0.043), which was confirmed in multivariable analysis (OR 0.36 95%CI 0.15 & ndash;0.87, p = 0.023). Major...Show moreBackground: Guidelines advise self-expanding metal stents (SEMS) over plastic stents in preoperative endoscopic biliary drainage (EBD) for malignant extrahepatic biliary obstruction. This study aims to assess nationwide practice and outcomes.Methods: Patients with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy were included from the Dutch Pancreatic Cancer Audit (2017 & ndash;2018). Multi variable logistic and linear regression models were performed.Results: In total, 575/1056 patients (62.0%) underwent preoperative EBD: 246 SEMS (42.8%) and 329 plastic stents (57.2%). EBD-related complications were comparable between the groups (44/246 (17.9%) vs. 64/329 (19.5%), p = 0.607), including pancreatitis (22/246 (8.9%) vs. 25/329 (7.6%), p = 0.387). EBD-related cholangitis was reduced after SEMS placement (10/246 (4.1%) vs. 32/329 (9.7%), p = 0.043), which was confirmed in multivariable analysis (OR 0.36 95%CI 0.15 & ndash;0.87, p = 0.023). Major postoperative complications did not differ (58/246 (23.6%) vs. 90/329 (27.4%), p = 0.316), whereas postoperative pancreatic fistula (24/246 (9.8%) vs. 61/329 (18.5%), p = 0.004; OR 0.50 95%CI 0.27 & ndash;0.94, p = 0.031) and hospital stay (14.0 days vs. 17.4 days, p = 0.005; B 2.86 95%CI & minus;5.16 to & minus;0.57, p = 0.014) were less after SEMS placement.Conclusion: This study found that preoperative EBD frequently involved plastic stents. SEMS seemed associated with lower risks of cholangitis and less postoperative pancreatic fistula, but without an increased pancreatitis risk.Show less
All authors
Latenstein, A.E.J.; Mackay, T.M.; Huijgevoort, N.C.M. van; Bonsing, B.A.; Bosscha, K.; Hol, L.; Bruno, M.J.; Coolsen, M.M.E. van; Festen, S.; Geenen, E. van; Koerkamp, B.G.; Hemmink, G.J.M.; Hingh, I.H.J.T. de; Kazemier, G.; Lubbinge, H.; Meijer, V.E. de; Molenaar, I.Q.; Quispel, R.; Santvoort, H.C. van; Seerden, T.C.J.; Stommel, M.W.J.; Venneman, N.G.; Verdonk, R.C.; Besselink, M.G.; Hooft, J.E. van; Dutch Pancreatic Canc Grp
Date
2021-02-01
Journal
HPB
Volume
23
Issue
2
Pages
270 - 278
DOI
doi:10.1016/j.hpb.2020.06.009
Link
http://www.hpbonline.org/article/S1365182X2031056X/pdf