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.
Aim: 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.
Patients and 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.
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.
Additional background information and discussion
This policy does not cover the use of MRI on patients with biliary stents that have been inserted outwith GRI, RAH and QEUH departments
In patients with a biliary stent inserted at GRI, RAH or QEUH sites can immediately following stent implantation, 1.5T or 3T MRI can safely proceed using the Normal Operating Mode of the scanner. Multiple pulse sequences per protocol are allowed but no single sequence can exceed 15 mins in length.
Risk assessment: A risk assessment underpinning this policy can be found here:
Must read: What this policy does not cover / notable exceptions
This policy covers the use of 1.5T and 3T MRI on patients with biliary stents inserted at GRI, RAH and QEUH departments.
This policy does not cover the use of MRI on patients with biliary stents that have been inserted outwith GRI, RAH and QEUH department
For risk assessment, see link below…
Must read: The MR safety policy