Endoscopy 2020; 52(S 01): S88-S89
DOI: 10.1055/s-0040-1704268
ESGE Days 2020 oral presentations
Friday, April 24, 2020 11:00 – 13:00 ERCP: Strictures and leaks Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

NATIONWIDE PRACTICE AND OUTCOMES OF ENDOSCOPIC BILIARY DRAINAGE IN RESECTABLE PANCREATIC HEAD AND PERIAMPULLARY CANCER

AEJ Latenstein
1   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
TM Mackay
1   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
NCM van Huijgevoort
2   Amsterdam UMC, Department of Gastroenterology, Amsterdam, Netherlands
,
BA Bonsing
3   Leiden University Medical Center, Department of Surgery, Leiden, Netherlands
,
K Bosscha
4   Jeroen Bosch Hospital, Department of Surgery, ‘s Hertogenbosch, Netherlands
,
L Hol
5   Maasstad Hospital, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands
,
MJ Bruno
6   Erasmus MC University Medical Center, Department of Gastroenterology & Hepatology, Rotterdam, Netherlands
,
ME van Coolsen
7   Maastricht University Medical Center, Department of Surgery, Maastricht, Netherlands
,
S Festen
8   Onze Lieve Vrouwe Gasthuis, Department of Surgery, Amsterdam, Netherlands
,
E van Geenen
9   Radboud University Medical Center, Department of Gastroenterology and Hepatology, Nijmegen, Netherlands
,
B Groot Koerkamp
10   Erasmus MC University Medical Center, Department of Surgery, Rotterdam, Netherlands
,
GJM Hemmink
11   Isala, Department of Gastroenterology and Hepatology, Zwolle, Netherlands
,
IHJT de Hingh
12   Catharina Hospital, Department of Surgery, Eindhoven, Netherlands
,
G Kazemier
1   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
H Lubbinge
13   Tjongerschans, Department of Gastroenterology and Hepatology, Heerenveen, Netherlands
,
VE de Meijer
14   University Medical Center Groningen, Department of Hepatobiliary Surgery and Liver Transplantation, Groningen, Netherlands
,
IQ Molenaar
15   Regional Academic Cancer Center Utrecht, Department of Surgery, Utrecht, Netherlands
,
R Quispel
16   Reinier de Graaf Ziekenhuis, Department of Gastroenterology and Hepatology, Delft, Netherlands
,
HC van Santvoort
15   Regional Academic Cancer Center Utrecht, Department of Surgery, Utrecht, Netherlands
,
TCJ Seerden
17   Amphia Hospital, Department of Gastroenterology and Hepatology, Breda, Netherlands
,
MWJ Stommel
18   Radboud University Medical Center, Department of Surgery, Nijmegen, Netherlands
,
NG Venneman
19   Medisch Spectrum Twente, Department Gastroenterology and Hepatology, Enschede, Netherlands
,
RC Verdonk
20   Regional Academic Cancer Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands
,
MG Besselink
1   Amsterdam UMC, Department of Surgery, Amsterdam, Netherlands
,
JE van Hooft
21   Amsterdam UMC, Department of Gastroenterology and Hepatology, Amsterdam, Netherlands
,
Dutch Pancreatic Cancer Group › Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

Also available at
 

Aims International guidelines advise self-expanding metal stents (SEMS) over plastic stents in case preoperative endoscopic biliary drainage (EBD) is indicated in malignant extrahepatic biliary obstruction. This study aims to assess the current nationwide practice and outcomes of EBD in resectable pancreatic head and periampullary cancer.

Methods All patients diagnosed with pancreatic head and periampullary cancer who underwent EBD before pancreatoduodenectomy between January 2017 and December 2018 were included from the mandatory Dutch Pancreatic Cancer Audit (17 centers). Multivariable logistic and linear regression models were performed.

Results In total, 575 of 1056 (54.4%%) patients underwent EBD prior to pancreatoduodenectomy. This included 246 (42.8%) SEMS and 329 (57.2%) plastic stents. SEMS placement varied from 0 to 77.1% between pancreatic centers (p< 0.001). EBD-related complications were comparable between SEMS and plastic stents (17.9% vs. 19.5%, p=0.607), including pancreatitis (8.9% vs. 7.6%, p=0.387). EBD-related cholangitis was reduced after SEMS placement (4.1% vs. 9.7%, p=0.043), which was confirmed in multivariable analysis (OR 0.36 95%CI 0.15-0.87, p=0.023). Major postoperative complications did not differ (23.6% vs. 27.4%, p=0.316), whereas both the rate of postoperative pancreatic fistula (9.8% vs. 18.5%, p=0.004; multivariable analysis: OR 0.50 95%CI 0.27-0.94, p=0.031) and hospital stay (14.0 days vs. 17.4 days, p=0.005; multivariable analysis B -2.86 95%CI -5,16–0.57, p =0.014) were less after SEMS placement.

Conclusions Nationwide performance of EBD was high whereas the use SEMS was low. SEMS was associated with lower risks of cholangitis, less postoperative pancreatic fistula, and a shorter postoperative hospital stay without increased risk of pancreatitis.