S38 Plastic vs Metal Stents for Preoperative Biliary Drainage in Patients With Resectable Pancreaticobiliary Neoplasias: A Retrospective Study

Abstract

Introduction: Obstructive jaundice is a common consequence of pancreatic and biliary malignancies. In surgical candidates for oncological resection, biliary obstruction is associated with high rates of peri-operative complications. Preoperative biliary drainage (PBD) constitutes the mainstay of treatment in patients with severe hyperbilirubinemia, cholangitis, delayed surgery or awaiting neoadjuvant therapy. While both plastic and metal stents have been used in this clinical context, it remains unclear which type of stent would yield a better clinical outcome in patients with resectable tumors. Methods: We performed a retrospective analysis of all patients with resectable pancreaticobiliary malignancy and significant obstructive jaundice who underwent preoperative biliary drainage (PBD) and subsequent pancreaticoduodenectomy (Whipple procedure) with curative intent between January 2014 and December 2020 at the CIUSSS de l’Estrie CHUS, a Canadian tertiary center. Clinical outcomes including endoscopic reintervention, stent-related adverse events, and stent efficacy (defined as biochemical decrease of total bilirubin value before surgery) were evaluated and compared between plastic and metal stent groups. Results: 44 patients were comprised in the final database, including 29 and 15 patients in the plastic and metal stent groups, respectively. Baseline characteristics were comparable in both groups. There was significantly more need for endoscopic reintervention for stent dysfunction (27,5% vs 0% P=0,037) in the plastic stent group versus the metal stent group and a tendency towards more PBD-related adverse events (31% vs 6,7% P= 0,08). Reduction of 50% of total bilirubin value was seen at 11 days for the plastic stent group vs 19 days for the metal stent group (p = 0,349). Only 3 (20%) patients in the metal stent group and 6 patients (21%) in the plastic stent group normalized their total bilirubin value before surgery (p = 1). The time from biliary drainage to surgical resection was similar in both groups (34 vs 36 days p = 0,862). Conclusion: While both plastic and metal stents seemed to have similar clinical efficacy for preoperative biliary drainage in malignant obstruction in our study, metal stents had significantly lower rates of reintervention and a tendency towards less procedure related complications than plastic stents. While larger studies are needed to confirm this finding and its related cost effectiveness, it currently seems reasonable to consider metal stents in this clinical context.Table 1.: Performance and efficiency of metal vs plastic stents for preoperative biliary drainage (PBD)