Duodenal invasion is a risk factor for the early dysfunction of biliary metal stents in unresectable pancreatic cancer

BackgroundAlthough the placement of self-expandable metal stents (SEMSs) has been widely accepted as palliation for distal malignant biliary obstruction, the risk factors for their early dysfunction remain unclear.ObjectiveTo identify risk factors for early (<3 months) SEMS dysfunction in unresectable pancreatic cancer.DesignA multicenter retrospective study.SettingFive tertiary referral centers.PatientsPatients were included who underwent first-time SEMS placement for distal malignant biliary obstruction caused by pancreatic cancer between April 1994 and August 2010.Main Outcome MeasurementsRates and causes of early dysfunction were evaluated, and risk factors were analyzed.ResultsIn all, 317 eligible patients were identified. Covered SEMSs were placed in 82% of patients. Duodenal invasion was observed endoscopically in 37%. The median time to dysfunction was 170 days. The rates of all and early SEMS dysfunction were 55% and 31%, respectively. The major causes of SEMS dysfunction were food impaction and nonocclusion cholangitis (21% each) in early dysfunction and sludge (29%) in nonearly dysfunction. The rate of early dysfunction was 42% with duodenal invasion and 24% without duodenal invasion (P = .001). Early dysfunction caused by food impaction was more frequent in patients with duodenal invasion (10% and 4%, P = .053). Duodenal invasion was a risk factor (odds ratio 2.35; 95% CI, 1.43–3.90; P = .001) in a multiple logistic regression model.LimitationsA retrospective design.ConclusionsDuodenal invasion is a risk factor for early SEMS dysfunction in patients with pancreatic cancer.