The application of combined biliary and duodenal stenting in the palliative treatment of pancreatic head carcinoma / 解放军医学杂志

ABSTRACT

Objective To explore the value of combined biliary and duodenal stenting in the palliative treatment of pancreatic head carcinoma. Methods From August 2003 to July 2005, four patients who were diagnosed as pancreatic head carcinoma presenting obstructive jaundice were treated with biliary stenting. When duodenal obstruction occurred due to the growth of the carcinoma , duodenal stents were placed to relieve the obstruction. Results The biliary and duodenal stents were successfully positioned in all 4 patients. After biliary stents were inserted, the level of total bilirubin value of each patient decreased by 50% in 24 hours and returned to normal range within 1 week. When the biliary stents were occluded, stent replacement or restenting was performed, and relief of obstructive jaundice was thus achieved. After duodenal stents were inserted, the symptoms of duodenal obstruction were relieved and the patients were able to tolerate peroral solid food. When the duodenal obstruction recurred, a second coaxial duodenal stent was inserted. Three duodenal stents were placed in one patient because of rgrowth in size of the carcinoma. No complications related to stenting were observed. Two patients were followed up until their death with survival time of 24 months and 22 months, respectively, who were free of jaundice and duodenal obstruction at the end of their life. Two patients are still in follow-up period (16 months and 9months after stenting, respectively), who are now free of jaundice and duodenal obstruction. Conclusion Biliary stenting combined with duodenal stenting can improve the life quality of patients with pancreatic head carcinoma and is an effective palliative treatment for these patients.