Self-expandable metal vs. plastic stents for preoperative biliary drainage in patients receiving neoadjuvant chemotherapy

Neoadjuvant chemotherapy (NAC) improves the rate of curative resection and overall prognosis in patients with resectable or borderline resectable pancreatic cancer. The treatment period from the initiation of NAC to surgery typically ranges from 2 to 6 months. In cases of malignant biliary obstruction caused by pancreatic cancer, maintaining preoperative biliary drainage (PBD) until surgery is essential to continue NAC. Minimizing adverse events related to endoscopic biliary drainage and avoiding perioperative adverse events are crucial. Plastic stents (PSs) are commonly used for PBD; however, the extended duration of PBD required for NAC increases the risk of recurrent biliary obstruction (RBO), potentially leading to discontinuation of NAC. Therefore, preventing RBO during PBD in patients with pancreatic cancer receiving NAC is important. The placement of self-expandable metal stents (SEMSs) for PBD significantly reduces the rate of RBO compared with PS placement. Although SEMS placement may increase the risk of pancreatitis or cholecystitis, its effect on postoperative outcomes is comparable to that of PS placement. Given their lower rate of RBO, SEMSs are considered more suitable than PSs for PBD in patients with pancreatic cancer receiving NAC.