Treatment, by Insertion of Multiple Uncovered Metallic Stents, of Intraductal Papillary Mucinous Neoplasm of the Pancreas with Biliary Obstruction by Mucus Impaction

Background/Aims: Biliary mucinous obstruction is a complication of intraductal papillary mucinous neoplasms (IPMN). Surgery with resection of the tumour or with biliary bypass is generally recommended. It is our aim to report a patient with IPMN complicated by biliary mucinous impaction in whom surgery was not possible because of extensive collateral circulation. Repeated insertions of plastic and of single covered metallic stents were unsuccessful due to mucus-induced migration of these stents. Methods: Three metallic uncovered stents were inserted in the bile duct alongside each other in order to fill the bile duct up with stent material. Results: Whereas previous insertions of single plastic or covered metallic stents were invariably followed by recurrence of cholestasis by spontaneous stent migration, insertion of three uncovered metallic stents was followed by absence of any cholestatic symptoms during a follow-up period of at least 4 years. Conclusion: In patients with IPMN complicated by biliary mucus impaction, the insertion of multiple uncovered metallic stents seems the endoscopic method of choice to prevent mucus-induced spontaneous Stent dislocation.