Background575 cases of pancreatic cancer were diagnosed in Norway in 2005. The overall survival of pancreatic cancer remains poor despite advances in diagnosis and treatment. Adequate symptom management is the major target in the palliative care of these patients. 10–15 % of palliative patients develop duodenal obstruction in the terminal phase of the disease. In the past several years, self-expanding metal stents have been used in the palliation of this condition.The objectives of the study were to investigate: • The incidence of duodenal obstruction in patients with pancreatic cancer at the time of referral to the palliative care unit at Ullevaal University Hospital.• Use and efficacy of self-expanding metal stents as palliative treatment of duodenal obstruction in pancreatic cancer in the current literature.
Methods26 patients with unresectable pancreatic cancer were interviewed according to a questionnaire regarding symptoms of duodenal obstruction including a gastric outlet obstruction scoring system. Data were collected between October 2006 and April 2007. A review of the published data was carried out by searching PubMed, Embase and Cochrane between 1996 and 2007. A total of 24 relevant publications were identified. The review included three case series and one review. Analysis of these four publications included data on type of used stent(s), stent placement technique, technical success, clinical success and complications.
ResultsA total of 26 patients were included. The most common symptom was bloating. 7.8 % of the patients had duodenal obstruction at the time of referral. Both endoscopic and fluoroscopic techniques were used for placement of non-coated and coated stents. Technical success was achieved in 95.9–97.3 % of the patients followed with a clinical success of 89.7–90.2 %. A total complication rate of 16.4–25.0 % was seen for non-coated stents versus 10.2 % for coated stents.
ConclusionsThe gastric outlet obstruction scoring system may be used in diagnose of duodenal obstruction in patients with pancreatic cancer. Use of self-expandable metal stents seems to be an effective treatment in the palliation of duodenal obstruction caused by pancreatic cancer. The procedure is associated with high technical and clinical success rates. Endoscopic guidance in stent placement seems to be advantageous compared to fluoroscopy alone. Coated stents have in total lower complication rates.