Self-expanding metal tubes or stents are a safe and effective treatment for obstructive jaundice

May 2 2005

One key goal of treating pancreatic cancer, which is often fatal within a year, is making sure patients have a good quality of life with as few complications as possible. This is especially important if they are candidates for surgical removal of the cancer.

Now, doctors at the University of Virginia Health System report that placing self-expanding metal tubes or stents (covered with a synthetic material) to drain the common bile duct is a safe and effective treatment for a major complication of pancreatic cancer-- obstructive jaundice. This type of jaundice occurs frequently when pancreatic tumors block the flow of bile from the liver. Cancer patients can experience yellowing of the skin and eyes, itching and dark urine. If untreated, jaundice can lead to infection and abscesses in the liver, which can be fatal.

"It is important that we can now relieve these very significant complications without the major surgery that can often lead to long-term hospitalization and possibly death," said Dr. Michel Kahaleh, a gastroenterologist and assistant professor of internal medicine at UVa's Digestive Health Center of Excellence. "We can provide resolution of jaundice and alleviate the symptoms for a long period of time, at least long enough until patients are able to have their cancer treated with surgery."

Between March 2001 and November 2004, UVa doctors inserted 88 stents called covered Wallstents (manufactured by Boston Scientific, Inc.) in 80 patients at UVa with bile duct obstructions from malignant cancer. These stents were developed to prevent the growth of tumors into the stent itself and feature a metallic skeleton bound to a synthetic covering resistant to bile and other gastric and pancreatic juices. Writing in the April 2005 issue of the journal Gastrointestinal Endoscopy, Kahaleh and his UVa colleagues report that the stents were still open in 90 percent of the patients after three months and were open in almost 80 percent of patients after one year. Complications, however, included migration (movement) of the stent, occlusion of the stent and obstructions of the cystic duct. The stents were easily removed and replaced where needed.

In an accompanying editorial in the same issue of Gastrointestinal Endoscopy, Dr. David L. Carr-Locke of Harvard Medical School wrote that covered metal stents to help palliate bile duct malignancy is "the appropriate step in stent technology development and probably confers a clinical advantage over its uncovered counterpart."