Large-diameter Plastic Stents as An Option for Preoperative Biliary Drainage for Patients with Pancreatic Cancer Undergoing Neoadjuvant Chemotherapy

Background/Aims: Fully covered self-expandable metallic stents (FCSEMSs) are used widely for the preoperative biliary drainage of pancreatic cancer because of their low recurrent biliary obstruction (RBO) rates. On the other hand, concerns about non-RBO adverse events (AEs), such as pancreatitis, have led to ongoing debate over the optimal stent. Therefore, this study aimed to clarify the clinical outcomes of preoperative biliary drainage using plastic stents (PSs) and FCSEMSs for patients with pancreatic cancer undergoing neoadjuvant chemotherapy (NAC). Methods: This study retrospectively reviewed consecutive patients (between June 2012 and September 2024) who underwent NAC following biliary drainage using either PSs or FCSEMSs and who were followed up until the decision for or against a surgical resection was made. Results: Forty-seven patients were included (PS, n=33; FCSEMS, n=14). The RBO rate was not significantly different (39% vs. 7.1%, p=0.081), whereas the time to RBO was significantly longer in the FCSEMS group (126 days vs. not reached, p=0.046). Non-RBO AEs were observed more frequently in the FCSEMS group (15% vs. 43%, p=0.061). The rate of overall AEs, including RBO and non-RBO AEs, was similar between the two groups (45% vs. 43%, p=1.000). Subgroup analysis between the PS ≥10 Fr (n=27) and FCSEMS groups showed no significant differences. Conclusions: Large-diameter PSs may be an alternative in selected patients at high risk of non-RBO AEs, including post-ERCP pancreatitis, but attention should be paid to the risk of RBO.