Comparing the efficacy and safety of metal versus plastic stents in preoperative biliary drainage.

Introduction: There is conflicting evidence regarding whether routine preoperative biliary drainage (PBD) should be performed if clinically warranted prior to a pylorus-preserving pancreaticoduodenectomy (PPP) for resectable pancreatic head cancer. In addition, there are limited studies that investigated whether PBD with metal or plastic biliary stents have differing impacts on PBD-related complication rates, post PPP surgical outcomes, and healthcare resource utilisation. Aims & Methods: An Australian multicentre retrospective cohort study was conducted which included patients who underwent PBD prior to PPP from 2010 to 2019. Patients included received PBD based on one or more of: cholangitis defined by revised Tokyo guidelines, level of total bilirubin >=40 mumol/L, expected time to operation >=7 days, or receiving neoadjuvant chemotherapy. The aim of this study was to compare PBD with fully covered self-expandable metal stent (FCSEMS) compared to plastic stents in terms of the rate of endoscopic reintervention, stent related complication and surgical complications in patients with resectable pancreatic head cancer who later underwent a PPD. Result(s): 106 patients underwent PBD. 32 patients (30.19%) received a FCSEMS versus 74 (69.81%) with plastic). The mean age was 66.75 +/- 9.79 years, 47.17% were male and the baseline bilirubin was 184.91 +/- 113.59 mumol/L. Both FCSEMS and plastic effectively reduced bilirubin (DELTA140.04 +/- 113.04 mumol/L from baseline) with no difference between the FCSEMS arm and the plastic arm (DELTA134.56 +/- 108.35 mumol/L vs DELTA152.19 +/- 123.74 mumol/L, p-value:0.47). There was no difference in the PBD complication rates in the FCSEMS and plastic stent groups respectively: readmission (p-value=0.40), pancreatitis (p-value=0.25), cholangitis (p-value=0.35), haemorrhage (p-value=0.51), stent occlusion without cholangitis (p-value=0.09), and reintervention with either ERCP or PTC (p-value=0.21). There were no cases of stent related