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Objectives: Unresectable ampullary cancer (AC) is a rare disease entity. The risk factors for recurrent biliary obstruction (RBO) following endoscopic biliary stenting (EBS) for unresectable AC remain unknown. In this study we aimed to evaluate the cumulative RBO rate and to identify risk factors for RBO following palliative EBS in patients with unresectable AC. Methods: This multicenter retrospective observational study enrolled consecutive patients with unresectable AC who had undergone palliative EBS between April 2011 and December 2021. The cumulative rate of and risk factors for RBO following palliative EBS were evaluated via multivariate analysis. Results: The study analysis comprised 107 patients with a median age of 84 years (interquartile range 79–88 years). Plastic stents (PSs) and self‐expandable metal stents (SEMSs) were placed in 53 and 54 patients, respectively. Functional success was accomplished in 104 (97.2%) patients. Of these, RBO occurred in 62 (59.6%) patients, with obstruction and complete/partial migration occurring in 47 and 15 patients, respectively. The median time to RBO was 190 days. Multivariate analysis showed that PS was associated with a higher rate of RBO compared to SEMS (hazard ratio [HR] 2.48; P < 0.01) and that the presence of common bile duct stones/sludge immediately after EBS was an independent risk factor for RBO (HR 1.99; P = 0.04). Conclusions: The use of SEMS compared to PS during EBS reduced the time to RBO in patients with unresectable AC. Common bile duct stones/sludge immediately after EBS was a risk factor for RBO. [ABSTRACT FROM AUTHOR]

Background and aims: Needle tract seeding after preoperative endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) for pancreatic body and tail cancer has been reported. This study aimed to investigate the long‐term outcomes, including the needle tract seeding ratio, of patients undergoing distal pancreatectomy for pancreatic body and tail cancer diagnosed preoperatively by EUS‐FNA. Methods: This retrospective, observational cohort study assessed patients from three university hospitals and 11 tertiary referral centers. All patients who underwent distal pancreatectomy for invasive cancer of the pancreatic body and tail between January 2006 and December 2015 were identified and reviewed. Needle tract seeding rate, recurrence‐free survival (RFS), and overall survival (OS) were evaluated. Results: Of the 301 total patients analyzed, 176 underwent preoperative EUS‐FNA (EUS‐FNA group) and 125 did not (non‐EUS‐FNA group). The median follow‐up periods of the EUS‐FNA group and non‐EUS‐FNA group were 32.8 and 30.1 months. Six patients (3.4%) in the EUS‐FNA group were diagnosed as having needle tract seeding. The 5‐year cumulative needle tract seeding rate estimated using Fine and Gray's method was 3.8% (95% CI 1.6–7.8%). The median RFS or OS was not significantly different between the EUS‐FNA group and the non‐EUS‐FNA group (23.7 vs 16.9 months: P = 0.205; 48.0 vs 43.9 months: P = 0.392). Conclusion: Although preoperative EUS‐FNA for pancreatic body and tail cancer has no negative effect on RFS or OS, needle tract seeding after EUS‐FNA was observed to have a non‐negligible rate. (UMIN000030719) [ABSTRACT FROM AUTHOR]

Objective: To elucidate the long‐term outcomes of permanent endoscopic biliary stenting (EBS) and risk factors for recurrent biliary obstruction (RBO) in high‐risk or elderly patients with common bile duct (CBD) stones. Methods: The electronic database of Hakodate Municipal Hospital was searched to identify elderly or high‐risk patients with CBD stones who had undergone permanent EBS using a plastic stent without stone removal and were followed up between April 2011 and May 2019, with no further intervention until symptoms occurred. Results: We analyzed a total of 47 patients, of whom 19 (40.4%) were men, with a median age of 86 years (interquartile range 80‐90 years). RBO and death without biliary disease occurred in 14 (29.8%) and 19 (40.4%) patients, respectively. The cumulative RBO rates at 20, 40, and 60 months were 22.1%, 31.8%, and 35.5%, respectively. The median time to RBO was 13.0 and 38.0 months in the group with CBD stone ≥15 mm and 11‐14 mm in diameter, respectively. The cumulative RBO incidence rate in the group with CBD stone ≤10 mm in diameter did not reach 50%. The cumulative RBO incidence rates were significantly different among the three groups based on the CBD stone diameter (competing risk analysis, P < 0.01). Multivariate analysis showed that an increase in CBD stone diameter predicted the increased risk of RBO (hazard ratio 1.26, P = 0.01). Conclusions: Permanent EBS is a feasible option for high‐risk patients with small CBD stones. [ABSTRACT FROM AUTHOR]

Background: Bilateral self‐expandable metallic stent (SEMS) placement for the management of unresectable malignant hilar biliary obstruction (UMHBO) is technically challenging to perform using the existing metallic stents with thick delivery systems. The recently developed 6‐Fr delivery systems could facilitate a single‐step simultaneous side‐by‐side placement through the accessory channel of the duodenoscope. The aim of this study was to evaluate the feasibility of this procedure. Methods: Between May and September 2013, 13 consecutive patients with UMHBO underwent a single‐step simultaneous side‐by‐side placement of SEMS with the 6‐Fr delivery system. The technical success rate, stent patency, and rate of complications were evaluated from the prospectively collected database. Results: Technical success was achieved in 11 (84.6%, 95% confidence interval [CI]: 57.8–95.8) patients. The median procedure time was 25 min. Early and late complications were observed in 23% (one segmental cholangitis and two liver abscesses) and 15% (one segmental cholangitis and one cholecystitis) patients, respectively. Median dysfunction free patency was 263 days (95% CI: 37–263). Five patients (38%) experienced stent occlusion that was successfully managed by endoscopic stent placement. Conclusions: A single‐step simultaneous side‐by‐side placement of SEMS with a 6‐Fr delivery system was feasible for the management of UMHBO. [ABSTRACT FROM AUTHOR]

The controversy over whether and how to perform preoperative biliary drainage (PBD) in patients with hilar cholangiocarcinoma (HCA) remains unsettled. Arguments against PBD before pancreatoduodenectomy have recently been gaining momentum. However, the complication-related mortality rate is as high as 10% for patients with HCA who have undergone major liver resection, and liver failure is a major cause of postoperative death. This suggests the need for PBD to treat jaundice in HCA patients scheduled for major surgical resection of the liver and that major surgery should be performed only after the recovery of hepatic function. No definite criteria or guidelines outlining indications for PBD are currently available. In patients with HCA, PBD may be performed by either percutaneous transhepatic biliary drainage (PTBD) or endoscopic biliary drainage (EBD). No consensus, however, has been reached regarding which drainage method is more appropriate. No reported study has compared the effectiveness of PTBD, endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD) in patients with HCA. This review summarizes the results of our study comparing the three methods and outlines the preoperative endoscopic management of segmental cholangitis (SC) in HCA patients undergoing PBD. [ABSTRACT FROM AUTHOR]

The article offers the authors' insights on their single-center observational study which examines the efficacy of percutaneous transhepatic biliary drainage (PTBD), endoscopic biliary stenting (EBS), and nasobiliary drainage (ENBD) in patients with perihilar bile duct cancer. They note that ENBD is considered the most suitable preoperative biliary drainage method based on decompression, complications and postsurgical morbidity. They suggest that EBS must be avoided and PTB should be limited.