{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T13:56:47Z","timestamp":1784642207712,"version":"3.55.0"},"reference-count":35,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T00:00:00Z","timestamp":1603324800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Endosc Int Open"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background and study aims\u2002Self-expandable metallic stents (SEMS) are now widely used even for patients with borderline resectable (BR) pancreatic cancer (PC), as neoadjuvant therapy has become common. Therefore, we conducted this study to evaluate safety of SEMS placement in the population including BR PC and to explore risk factors for recurrent biliary obstruction (RBO), pancreatitis, and cholecystitis.<\/jats:p><jats:p>\n          Patients and methods\u2002We retrospectively investigated consecutive patients with PC who received initial SEMS between January 2015 and March 2019. We compared time to RBO (TRBO), causes of RBO, and stent-related adverse events (AEs) according to resectability status. Univariate and multivariate analyses were performed to explore risk factors for TRBO, pancreatitis, and cholecystitis.<\/jats:p><jats:p>\n          Results\u2002A total of 135 patients were included (BR 31 and unresectable [UR] 104). Stent-related AEs occurred in 39 patients: pancreatitis 14 (mild\/moderate\/severe 1\/6\/7), cholecystitis 12, and non-occluding cholangitis 13. TRBO, causes of RBO, and stent-related AEs were not significantly different according to resectability status. Overall rate of RBO was higher in UR PC due to the longer follow-up period. Sharp common bile duct (CBD) angulation was an independent risk factor for short duration of TRBO. High pancreatic volume index and SEMS of high axial force were independent risk factors for pancreatitis, whereas tumor involvement to orifice of cystic duct was the only risk factor for cholecystitis.<\/jats:p><jats:p>\n          Conclusions\u2002We demonstrated that SEMS can be safely deployed even in patients with BR PC. Sharp CBD angulation and high pancreatic volume index were identified as novel risk factors for RBO and pancreatitis, respectively, after SEMS placement.<\/jats:p>","DOI":"10.1055\/a-1244-1989","type":"journal-article","created":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T23:16:38Z","timestamp":1603408598000},"page":"E1603-E1610","source":"Crossref","is-referenced-by-count":22,"title":["Novel risk factors for recurrent biliary obstruction and pancreatitis after metallic stent placement in pancreatic cancer"],"prefix":"10.1055","volume":"08","author":[{"given":"Tsuyoshi","family":"Takeda","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Sasaki","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takafumi","family":"Mie","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takaaki","family":"Furukawa","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryo","family":"Kanata","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akiyoshi","family":"Kasuga","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Matsuyama","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masato","family":"Ozaka","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Sasahira","sequence":"additional","affiliation":[{"name":"Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,10,22]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21387","article-title":"Cancer Statistics, 2017","volume":"67","author":"R L Siegel","year":"2017","journal-title":"CA Cancer J Clin"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1016\/j.cgh.2016.05.034","article-title":"Global Trends in pancreatic cancer mortality from 1980 through 2013 and predictions for 2017","volume":"14","author":"A L Lucas","year":"2016","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"271","DOI":"10.21873\/invivo.11471","article-title":"Improvement of treatment outcomes for metastatic pancreatic cancer: a real-world data analysis","volume":"33","author":"T Sasaki","year":"2019","journal-title":"In Vivo"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1097\/SLA.0b013e3181613142","article-title":"Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible?","volume":"247","author":"T Schnelldorfer","year":"2008","journal-title":"Ann Surg"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.jamcollsurg.2014.12.031","article-title":"Two thousand consecutive pancreaticoduodenectomies","volume":"220","author":"J L Cameron","year":"2015","journal-title":"J Am Coll Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1002\/bjs.10870","article-title":"Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer","volume":"105","author":"E Versteijne","year":"2018","journal-title":"Br J Surg"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1016\/j.surg.2016.06.010","article-title":"Overall survival is increased among stage III pancreatic adenocarcinoma patients receiving neoadjuvant chemotherapy compared to surgery first and adjuvant chemotherapy: An intention to treat analysis of the National Cancer Database","volume":"160","author":"C R Shubert","year":"2016","journal-title":"Surgery"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1186\/s12957-017-1240-2","article-title":"Neoadjuvant treatment of pancreatic adenocarcinoma: a systematic review and meta-analysis of 5520 patients","volume":"15","author":"M Dhir","year":"2017","journal-title":"World J Surg Oncol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.ejso.2018.07.057","article-title":"Neoadjuvant FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer: An intention to treat analysis","volume":"44","author":"A Barenboim","year":"2018","journal-title":"Eur J Surg Oncol"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1016\/j.ejso.2016.01.006","article-title":"Preoperative treatment with gemcitabine plus nab-paclitaxel is a safe and effective chemotherapy for pancreatic adenocarcinoma","volume":"42","author":"B Ielpo","year":"2016","journal-title":"Eur J Surg Oncol"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.3389\/fonc.2019.01085","article-title":"Neoadjuvant therapy for resectable pancreatic cancer: an evolving paradigm shift","volume":"9","author":"A Chawla","year":"2019","journal-title":"Frontiers Oncol"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1093\/jjco\/hyy190","article-title":"Randomized phase II\/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02\/JSAP05)","volume":"49","author":"F Motoi","year":"2019","journal-title":"Jpn J Clin Oncol"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/j.1443-1661.2011.01124.x","article-title":"Results of a Japanese multicenter, randomized trial of endoscopic stenting for non-resectable pancreatic head cancer (JM-test): Covered Wallstent versus DoubleLayer stent","volume":"23","author":"H Isayama","year":"2011","journal-title":"Dig Endosc"},{"key":"ref14","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1038\/ajg.2016.512","article-title":"Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses","volume":"112","author":"M A Almadi","year":"2017","journal-title":"Am J Gastroenterol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/den.12049","article-title":"Covered self-expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer","volume":"26","author":"K Kubota","year":"2014","journal-title":"Dig Endosc"},{"key":"ref16","doi-asserted-by":"crossref","first-page":"460","DOI":"10.1016\/j.gie.2016.02.047","article-title":"Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial","volume":"84","author":"T B Gardner","year":"2016","journal-title":"Gastrointest Endosc"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1007\/s10620-012-2482-z","article-title":"Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: outcomes in 241 patients","volume":"58","author":"A A Siddiqui","year":"2013","journal-title":"Dig Dis Sci"},{"key":"ref18","doi-asserted-by":"crossref","first-page":"7968201","DOI":"10.1155\/2016\/7968201","article-title":"Preoperative biliary drainage in cases of borderline resectable pancreatic cancer treated with neoadjuvant chemotherapy and surgery","volume":"2016","author":"T Tsuboi","year":"2016","journal-title":"Gastroenterol Res Pract"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"2056","DOI":"10.1111\/j.1572-0241.2005.42031.x","article-title":"Use of expandable metallic biliary stents in resectable pancreatic cancer","volume":"100","author":"S M Wasan","year":"2005","journal-title":"Am J Gastroenterol"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1136\/gutjnl-2014-308762","article-title":"Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer","volume":"65","author":"J A Tol","year":"2016","journal-title":"Gut"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.6004\/jnccn.2017.0131","article-title":"Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology","volume":"15","author":"M A Tempero","year":"2017","journal-title":"J Natl Compr Canc Netw"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"637","DOI":"10.5946\/ce.2013.46.6.637","article-title":"Late Complications and stone recurrence rates after bile duct stone removal by endoscopic sphincterotomy and large balloon dilation are similar to those after endoscopic sphincterotomy alone","volume":"46","author":"K Y Kim","year":"2013","journal-title":"Clin Endosc"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1111\/den.12379","article-title":"TOKYO criteria 2014 for transpapillary biliary stenting","volume":"27","author":"H Isayama","year":"2015","journal-title":"Dig Endosc"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.gie.2009.10.027","article-title":"A lexicon for endoscopic adverse events: report of an ASGE workshop","volume":"71","author":"P B Cotton","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1038\/bmt.2012.244","article-title":"Investigation of the freely available easy-to-use software 'EZR' for medical statistics","volume":"48","author":"Y Kanda","year":"2013","journal-title":"Bone Marrow Transplant"},{"key":"ref26","doi-asserted-by":"crossref","first-page":"536","DOI":"10.1055\/s-0042-102651","article-title":"Risk factors for recurrent biliary obstruction following placement of self-expandable metallic stents in patients with malignant perihilar biliary stricture","volume":"48","author":"S Miura","year":"2016","journal-title":"Endoscopy"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1007\/s00464-005-0656-x","article-title":"An angulated common bile duct predisposes to recurrent symptomatic bile duct stones after endoscopic stone extraction","volume":"20","author":"D Keizman","year":"2006","journal-title":"Surg Endosc"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1080\/00365521.2018.1438507","article-title":"Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy","volume":"53","author":"E S Yoo","year":"2018","journal-title":"Scand J Gastroenterol"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/j.1440-1746.2012.07283.x","article-title":"Predictive factors for pancreatitis and cholecystitis in endoscopic covered metal stenting for distal malignant biliary obstruction","volume":"28","author":"S Shimizu","year":"2013","journal-title":"J Gastroenterol Hepatol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1007\/s00464-011-1950-4","article-title":"Risk factors for pancreatitis following transpapillary self-expandable metal stent placement","volume":"26","author":"K Kawakubo","year":"2012","journal-title":"Surg Endosc"},{"key":"ref31","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.gie.2010.05.023","article-title":"Risk of post-ERCP pancreatitis with placement of self-expandable metallic stents","volume":"72","author":"G A Cote","year":"2010","journal-title":"Gastrointest Endosc"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.14878","article-title":"Positive correlation between pancreatic volume and post-endoscopic retrograde cholangiopancreatography pancreatitis","author":"H Maruyama","year":"2019","journal-title":"J Gastroenterol Hepatol"},{"key":"ref33","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1111\/jgh.12582","article-title":"Metallic stent with high axial force as a risk factor for cholecystitis in distal malignant biliary obstruction","volume":"29","author":"Y Nakai","year":"2014","journal-title":"J Gastroenterol Hepatol"},{"key":"ref34","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1016\/j.gie.2006.06.022","article-title":"Risk factors for cholecystitis after metal stent placement in malignant biliary obstruction","volume":"64","author":"K T Suk","year":"2006","journal-title":"Gastrointest Endosc"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1016\/j.cgh.2006.06.004","article-title":"Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction","volume":"4","author":"H Isayama","year":"2006","journal-title":"Clin Gastroenterol Hepatol"}],"container-title":["Endoscopy International Open"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1244-1989.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,22]],"date-time":"2020-10-22T23:17:09Z","timestamp":1603408629000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1244-1989"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,22]]},"references-count":35,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,10,21]]},"published-print":{"date-parts":[[2020,11]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1244-1989","relation":{},"ISSN":["2364-3722","2196-9736"],"issn-type":[{"value":"2364-3722","type":"print"},{"value":"2196-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,22]]}}}