Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer

doi:10.4253/wjge.v17.i11.111107

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World Journal of Gastrointestinal Endoscopy

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World J Gastrointest Endosc. Nov 16, 2025; 17(11): 111107
Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.111107

Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer

Shohei Asada, Koh Kitagawa, Junichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Akira Mitoro, Minako Nagai, Hitoshi Yoshiji, Masayuki Sho

Shohei Asada, Koh Kitagawa, Junichi Hanatani, Yuki Motokawa, Yui Osaki, Tomihiro Iwata, Kosuke Kaji, Hitoshi Yoshiji, Department of Gastroenterology, Nara Medical University, Kashihara 634-8522, Nara, Japan

Akira Mitoro, Division of Endoscopy, Nara Medical University, Kashihara 634-8522, Nara, Japan

Minako Nagai, Masayuki Sho, Department of Surgery, Nara Medical University, Kashihara 634-8522, Nara, Japan

Author contributions: Kitagawa K, Asada S contributed to conceptualization; Hanatani J, Motokawa Y, Osaki Y, Iwata T, Kaji K contributed to data curation; Hanatani J, Motokawa Y, Osaki Y, Iwata T, Kaji K, Nagai M, Mitoro A contributed to investigation; Kitagawa K, Asada S contributed to methodology, project administration, resources, visualization, validation, writing the original draft; Yoshiji H, Sho M contributed to writing review and editing, supervision.

Institutional review board statement: This single-center retrospective study was approved by the Nara Medical University Ethics Committee (4018).

Informed consent statement: This retrospective observational study does not contain identifiable personal information. We published details about the study on our website to allow patients to opt out if they wish.

Conflict-of-interest statement: Koh Kitagawa has received a speaker honorarium from Boston Scientific Japan. Koh Kitagawa has received a consulting fee from M.I. Tech.

Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Koh Kitagawa, MD, PhD, Department of Gastroenterology, Nara Medical University, 840 Shijou-cho, Kashihara 634-8522, Nara, Japan. kitagawa@naramed-u.ac.jp

Received: June 24, 2025
Revised: August 10, 2025
Accepted: September 16, 2025
Published online: November 16, 2025
Processing time: 144 Days and 6.8 Hours

Abstract

BACKGROUND

Neoadjuvant therapy (NAT) for pancreatic cancer (PC) is becoming standardized, with neoadjuvant chemoradiotherapy (NACRT) showing proven effectiveness. However, the optimal endoscopic biliary drainage approach during NAT remains controversial. In this single-center retrospective case series, we report the use of a novel multi-hole self-expandable metallic stent (MH-SEMS) for preoperative biliary drainage during NACRT in patients with PC.

AIM

To assess the feasibility of endoscopic biliary drainage using MH-SEMS during NACRT in patients with malignant distal biliary obstruction secondary to resectable and borderline resectable PC.

METHODS

We included 14 patients—10 with resectable, 2 with borderline resectable, and 2 with unresectable locally advanced disease—who had undergone surgery after biliary drainage using MH-SEMS (diameter: 10 mm). Clinical and technical success was achieved in all patients, with a median interval of 105 days between stent placement and surgery.

RESULTS

A partial response was observed in five patients (35.7%), whereas nine patients (64.3%) exhibited stable disease. Only one patient (7.1%) developed moderate cholangitis from recurrent biliary obstruction caused by sludge 337 days after stent placement during systemic chemotherapy, requiring MH-SEMS replacement. Pathological examination of postoperative specimens revealed tumor shrinkage in many cases, and no stent migration was observed. Adverse events included mild pancreatitis in two patients (14.3%) and moderate pancreatitis in one patient (7.1%), as defined by the Tokyo Criteria 2024.

CONCLUSION

No cases of cholecystitis, liver abscess, or hemorrhage were reported. No disadvantages in surgical procedures or postoperative complications related to MH-SEMS placement were observed.

Keywords: Malignant biliary obstruction; Multi-hole self-expandable metallic stent; Neoadjuvant therapy; Neoadjuvant chemoradiotherapy; Pancreatic cancer

Core Tip: We investigated the usefulness of a novel multi-hole self-expandable metallic stent (MH-SEMS) for preoperative biliary drainage during neoadjuvant chemoradiotherapy (NACRT) in patients with pancreatic cancer (PC). We included 14 patients who underwent surgery following biliary drainage using MH-SEMS. Clinical and technical success were achieved in all patients. The median interval between stent placement and surgery was 105 days. Only one patient (7.1%) experienced recurrent biliary obstruction caused by sludge. MH-SEMS placement is a potentially effective treatment option for preoperative biliary drainage in patients with PC undergoing NACRT.