PTH-026 Pre-Operative Endoscopic Management of Biliary Obstruction in Pancreatic Cancer: Are Esge Guidelines Relevant and Achievable In The UK?

Abstract

Introduction The risks of routine preoperative biliary drainage in pancreatic cancer patients without cholangitis and bilirubin Methods Patients with a diagnosis of pancreatic cancer during 2014 were identified and cross-referenced with our HPB surgical database. We examined patient demographics, diagnostic modality, tumour site and type, whether pre-operative drainage was performed with endoscopic retrograde cholangio-pancreatography (ERCP) or percutaneous trans-hepatic cholangiography (PTC) and stent choice. Clinical outcomes included ERCP and surgical technical success as well as re-intervention rates. Results 135 pancreatic cancer cases (70 men; mean age 69±8 years, 65 women; mean age 72±7 years) were identified. Pathological diagnosis from EUS-FNA (n = 42), EUS-FNB (n = 34) or brush cytology (n = 24) was adenocarcinoma (n = 95), adenosqamous carcinoma (n = 2), mucinous adenocarcinoma (n = 2), neuroendocrine tumour (NETs; n = 9), squamous carcinoma (n = 2) and 25 radiological diagnosis alone. 50/135 (37%) patients underwent ERCP with technical success in 29/50 (58%): 14 plastic stents; 10 fr (n = 10), 7 fr (n = 4); and 15 self-expanding metal stents (SEMS); 10 mm fc-SEMS; 4 cm (n = 2), 6 cm (n = 2), 8 cm (n = 2); 10 mm uc-SEMS; 4 cm (n = 3), 6 cm (n = 5) were inserted. ERCP failure was due to either unsuccessful CBD cannulation and stenting (15/21; 71%) or duodenal obstruction (6/21; 29%) and 16/21 (76%) of these had PTC, were resected 2/21 (9%) or palliated 3/21 (14%). Re-intervention following ERCP stenting was required in 8/29 (28%): plastic stents 6/8 (75%) obstruction/cholangitis, SEMS 2/8 (25%) distal migration. 10/15 (67%) with SEMS inserted died 27/135 (20%) cases underwent surgery: complete resection 10/27 (R0; 37%), incomplete resection 7/27 (R1; 26%), palliative bypass 7/27 (26%) after a mean delay of 26 d (adenocarcinoma) and 90 d (NETs). 3/27 (11%) developed disease recurrence. In patients with biliary obstruction (9/27 who underwent surgery), 5/9 (55%) had surgical resection without attempted pre-operative drainage, with mean bilirubin 144μmol/L. Conclusion Following diagnosis of pancreatic cancer, few patients had surgical resection without prior drainage and overall Disclosure of Interest None Declared