Endoscopic biliary stenting for the palliation of pancreatic cancer: results, survival predictive factors, and comparison of 10-French with 11.5-French gauge stents.

Objectives: To compare the efficacy and complications of different stent lengths and diameters in the palliation of jaundice caused by pancreatic cancer, as well as investigate survival predictive factors and the success of endoscopic therapy.

Methods: This study summarizes our results with 103 pancreas cancer patients treated by endoscopic plastic biliary stenting, of whom 87 were followed up until death or the time of writing. Before therapy, bilirubinemia, tumor primary size, presence of distant metastases, and signs of duodenal involvement were evaluated as prognosis risk factors. In a retrospective, nonrandomized fashion, we compared the efficacy and complications (especially clogging) of 10-French versus 11.5-French gauge stents and of "short" (< or = 8 cm) versus "long" (> or = 9 cm) prostheses.

Results: Thirty six men and 51 women (median age 74 yr) with pancreatic cancer were analyzed. Stenting could abolish jaundice or make it imperceptible (bilirubinemia < 3 mg %) in 74 patients (85%). Median bilirubinemia after treatment decreased from 13.9 mg/dl to 1.0 mg/dl. Hospital mortality was 2.7%. The commonest long term complication was clogging, which occurred 66 times in 33 patients. Median stent patency was 3 and 4 months for 10-F gauge and 11.5-F gauge stents, respectively (p > 0.05). When analyzing the patients who were alive 6 months after therapy, the clogging rate was 46% and 55% for 10-F and 11.5-F stents, respectively (p > 0.05). The length also did not influence stent patency. The only risk factor assessed before therapy, which independently predicted survival, was the presence of distant metastases. Median survival for patients with metastatic disease was 2.5 months and 9 months for those without metastases (p = 0.0015).

Conclusions: We conclude that 10-F and 11.5-F stents have the same efficacy in the palliative management of malignant obstructive jaundice due to cancer of the pancreas. Detection of distant metastases is the best outcome predictive factor in these patients and should be regarded as a restriction to the insertion of biliary metal stents.