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Long-term outcomes of duckbill-type anti-reflux metal stents versus conventional covered metal stents in reinterventions after covered biliary metal stent dysfunction in unresectable pancreatic cancer

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Abstract

Background

The use of duckbill-type anti-reflux metal stents (DMS) in reinterventions after covered metal stent (CMS) dysfunction has been reported in patients with distal malignant biliary obstruction (MBO). However, the superiority of DMS over conventional CMS (c-CMS) has not been established. Therefore, we conducted this retrospective study to evaluate the long-term efficacy and safety of DMS as a second stent in comparison with c-CMS.

Methods

We investigated consecutive patients with distal MBO due to unresectable pancreatic cancer who underwent reintervention after dysfunction of initial biliary CMS at our institution. We compared causes of recurrent biliary obstruction (RBO), time to RBO (TRBO), adverse events (AEs), and reintervention rates of DMS and c-CMS in this stenting.

Results

A total of 76 patients were included (DMS 41 and c-CMS 35). While overall RBO rates were similar between the two groups (46% vs. 63%, p = 0.172), RBO due to non-occlusion cholangitis tended to be less frequent in the DMS group than in the c-CMS group (2% vs. 14%, p = 0.089). Median TRBO was significantly longer in the DMS group (286 days vs. 112 days, p = 0.029). DMS was identified as the only significant risk factor for TRBO (hazard ratio, 0.52; p = 0.044). Overall AE rates were significantly lower in the DMS group (2% vs. 23%, p = 0.010), with non-occlusion cholangitis being the most common AE in the c-CMS group. Endoscopic reintervention was successfully performed in all patients in both groups, despite failed stent removal in 15% of patients in DMS group.

Conclusions

DMS was associated with a significantly longer TRBO and lower rate of AEs compared with c-CMS in reinterventions after initial CMS dysfunction. DMS may be preferable to c-CMS as a second stent after biliary CMS dysfunction.

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Abbreviations

MBO:

Malignant biliary obstruction

PC:

Pancreatic cancer

SEMS:

Self-expandable metal stent

CMS:

Covered metal stent

RBO:

Recurrent biliary obstruction

c-CMS:

Conventional covered metal stent

ARMS:

Anti-reflux metal stent

ARV:

Anti-reflux valve

DMS:

Duckbill-type anti-reflux metal stent

ENBD:

Endoscopic nasobiliary drainage

NSAIDs:

Nonsteroidal anti-inflammatory drugs

TRBO:

Time to recurrent biliary obstruction

AE:

Adverse event

OS:

Overall survival

ECOG:

Eastern Cooperative Oncology Group

PS:

Performance status

HR:

Hazard ratio

CI:

Confidence interval

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Funding

The authors received no specific funding for this study.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto, Tokyo, 135-8550, Japan

    Tsuyoshi Takeda, Takashi Sasaki, Yuto Yamada, Takeshi Okamoto, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka & Naoki Sasahira

  2. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Omori Medical Center, Toho University, Tokyo, Japan

    Yuto Yamada

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  1. Tsuyoshi Takeda
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  2. Takashi Sasaki
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  3. Yuto Yamada
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Corresponding author

Correspondence to Takashi Sasaki.

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Disclosure

Dr. Takashi Sasaki received honoraria from Kawasumi Laboratories, Boston Scientific Japan, Century Medical, Cook Japan. Dr. Naoki Sasahira received honoraria from Boston Scientific, Gadelius Medical, Kawasumi Laboratories. Drs. Tsuyoshi Takeda, Yuto Yamada, Takeshi Okamoto, Takafumi Mie, Takaaki Furukawa, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka have no conflicts of interest or financial ties to disclose.

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Takeda, T., Sasaki, T., Yamada, Y. et al. Long-term outcomes of duckbill-type anti-reflux metal stents versus conventional covered metal stents in reinterventions after covered biliary metal stent dysfunction in unresectable pancreatic cancer. Surg Endosc 37, 3498–3506 (2023). https://doi.org/10.1007/s00464-022-09836-0

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