Biliary tract prosthesis combined with pancreatic duct stents in patients with periampullary carcinoma

Abstract

Objective To evaluate the efficacy of biliary tract prosthesis and pancreatic duct stents for advanced periampullary carcinoma. Methods A total of 36 patients were diagnosed as advanced periampullary carcinoma pathologically or clinically, with strictures both in pancreatic and biliary ducts confirmed by imaging. Teflon stents were firstly implanted through endoscopy to the narrowed pancreatic ducts, expansible metal prosthesis were then implanted to the biliary tract. If failed, the metal stents were given through percutaneous transhepatic biliary drainage （ PTCD ） pathway. Serum levels of liver enzymes, amylase and clinical manifestations were observed before and after operation. Results Teflon stents were successfully implanted into pancreatic ducts in all patients. Metal prostheses into bile ducts were endoscopically implanted in 29 cases, and via PTCD in 7, including 2 cases of Billroth II gastrectomy. The levels of liver enzymes significantly decreased （P 〈 0. 01 ） after stents implacement. The levels of amylase （plasma and urine） and lipase increased in 15 cases, but they were corrected to normal levels after adequate treatments. Rates of abdominal pain relieving and diahhrea improvement were 82. 4% （28/34） and 88. 2% （ 15/17 ）, respectively. Conclusion The combined implacement of biliary tract prosthesis and pancreatic duet stents is safe and effective in relieving malignant obstruction in periampullary carcinoma. Key words: Biliary tract neoplasms; Malignant obstruction; Bile ducts ; Pancreatic duets; Stents