SNFGE SNFGE
 
Thématique :
- Endoscopie/Imagerie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Emmanuel CORON
Coup de coeur :
 
 
Gut
  2015/08  
 
  2016;65:1981-1987  
  doi: 10.1136/gutjnl-2014-308762  
 
  Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer  
 
  J A M G Tol, J E van Hooft, R Timmer, F J G M Kubben, E van der Harst, I H J T de Hingh, F P Vleggaar, I Q Molenaar, Y C A Keulemans, D Boerma, M J Bruno, E J Schoon, N A van der Gaag, M G H Besselink, P Fockens, T M van Gulik, E A J Rauws, O R C Busch, D J Gouma  
  http://gut.bmj.com/content/65/12/1981.abstract?sid=dd42ab33-b59d-41a0-8168-f3a7bb9731b9  
 
 

Abstract

Introduction In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk.

Methods A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT’s plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed.

Results 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients’ characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%.

Conclusions For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated.

 
Question posée
 
Faut-il préférer les stents métalliques couverts aux stents plastiques pour le drainage biliaire pré-opératoire des cancers du pancréas ?
 
Question posée
 
Les stents métalliques couverts ont un taux moindre de complications que les stents plastiques et ne modifient pas le risque opératoire des patients. Ils doivent donc être préférés aux stents plasiques.
 
Commentaires

La méthodologie de l’étude est critiquable mais les résultats vont dans le sens des études récentes, en faveur des stents métalliques couverts dans cette indication lorsqu’une chirurgie précoce n’est pas réalisable.

 
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