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©The Author(s) 2025.
World J Gastrointest Endosc. Nov 16, 2025; 17(11): 111107
Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.111107
Published online Nov 16, 2025. doi: 10.4253/wjge.v17.i11.111107
Table 1 Participant characteristics, n (%)/median (range)
| Participant characteristics | n = 14 | |
| Age (years) | 70 (63-73) | |
| Sex (male) | 6 (42.9) | |
| ECOG Performance status score | 0 | 12 (85.7) |
| 1 | 2 (14.3) | |
| Surgically altered anatomy | Total gastrectomy (Roux-en Y reconstruction) | 1 (7.1) |
| Distal gastrectomy (Billroth I reconstruction) | 1 (7.1) | |
| Intact gallbladder | 13 (92.9) | |
| Tumor size (during SEMS placement), mm, median (range) | 25 (13-40) | |
| Tumor location | Head | 13 (92.9) |
| Body | 1 (7.1) | |
| Resectability | Resectable | 10 (71.4) |
| Borderline resectable | 2 (14.3) | |
| Unresectable locally advanced | 2 (14.3) | |
| Clinical stage (JPS 8th) | IIA | 11 (78.6) |
| IIB | 1 (7.1) | |
| III | 2 (14.3) | |
| Duodenal invasion | 1 (7.1) | |
| Tumor invasion to the cystic duct | 3 (21.4) | |
| Biliary stricture length (mm), median (range) | 20 (9-40) | |
| Maximum diameter of the common bile duct (mm), median (range) | 13 (7-16) | |
| Tumor involvement in the main pancreatic duct | 7 (50.0) | |
| Maximum diameter of the pancreatic duct (mm), median (range) | 4.5 (2-10) | |
| Laboratory data before the SEMS placement | ||
| Total bilirubin (mg/dL) | 3.2 (0.9-7.3) | |
| Aspartate aminotransferase (IU/L) | 142 (53-581) | |
| Alanine aminotransferase (IU/L) | 271 (78-773) | |
| Amylase (U/L) | 53 (19-114) | |
| Carcinoembryonic antigen (ng/mL) | 5.4 (0.6-63.2) | |
| Carbohydrate antigen 19-9 (U/mL) | 134 (2-6711) | |
| Duodenal pancreatic cancer antigen 2 (U/mL) | 219 (25-1600) | |
| Previous drainage | Plastic stent | 7 (50.0) |
| None | 7 (50.0) | |
| Timing of MH-SEMS placement (including exchange from plastic stent) | Before starting systemic chemotherapy and NACRT | 14 (100) |
| After starting systemic chemotherapy or NACRT | 0 | |
| Cannulation methods | ||
| Catheter with contrast medium injection and guidewire | 11 (78.6) | |
| Pancreatic guidewire | 3 (21.4) | |
| Accidental contrast medium injection into the pancreatic duct | 6 (42.9) | |
| Endoscopic sphincterotomy | 0 | |
| Stent length | 6 cm | 1 (7.1) |
| 7 cm | 12 (85.7) | |
| 8 cm | 1 (7.1) | |
| Stent diameter | 10 mm | 14 (100) |
| Stent placement across the cystic duct orifice | 7 (50.0) | |
| Systemic chemotherapy for TNT (yes) | 4 (28.6) | |
| Regimens | GnP | 4 (28.6) |
| mFFX | 1 (7.1) | |
| SOXIRI | 2 (14.3) | |
| NACRT (yes) | 14 (100) | |
| Regimens | Gemcitabine + IMRT (54 Gy) | 13 (92.9) |
| Gemcitabine + S1 + IMRT (54 Gy) | 1 (7.1) | |
| Anticoagulation medication | 0 (0) | |
Table 2 Clinical outcomes and adverse events, n (%)/median (range)
| Outcomes | n = 14 | |
| Technical success | 14 (100) | |
| Clinical success | 14 (100) | |
| Neoadjuvant chemoradiotherapy completion | 13 (92.9) | |
| Radiotherapy protocol completion | 14 (100) | |
| Chemotherapy protocol completion | 13 (92.9) | |
| Tumor size (after neoadjuvant chemoradiotherapy), mm | 20 (5-30) | |
| Therapeutic effects based on imaging studies (RECIST) | PR | 5 (35.7) |
| SD | 9 (64.3) | |
| Tumor marker immediately before surgery | ||
| Carcinoembryonic antigen (ng/mL) | 2.7 (0.8-10.6) | |
| Carbohydrate antigen 19-9 (U/mL) | 19 (2-87) | |
| Duodenal pancreatic cancer antigen 2 (U/mL) | 42 (25-494) | |
| Biliary drainage–related adverse events | ||
| Pancreatitis | 3 (21.4) | |
| Grade | Mild | 2 (14.3) |
| Moderate | 1 (7.1) | |
| Cholecystitis | 0 | |
| Nonocclusive cholangitis | 0 | |
| Liver abscess | 0 | |
| Hemorrhage | 0 | |
| RBO | ||
| Incidence rate | 1 (7.1) | |
| Grade | Moderate | 1 (7.1) |
| Cause | Sludge | 1 (7.1) |
| Time to RBO (days) | 337 | |
| Reintervention method | Replacement with the same MH-SEMS | 1 (7.1) |
| Systemic chemotherapy–related adverse events (CTCAE grade ≥ 3) | ||
| GnP (n = 4) | Neutrophil count decreased | 3 (75.0) |
| Anemia | 1 (25.0) | |
| Malaise | 1 (25.0) | |
| mFFX (n = 1) | Neutrophil count decreased | 1 (100) |
| Malaise | 1 (100) | |
| Anorexia | 1 (100) | |
| SOXIRI (n = 2) | Neutrophil count decreased | 2 (100) |
| Malaise | 1 (50.0) | |
| Diarrhea | 1 (50.0) | |
| NACRT–related adverse events (CTCAE grade ≥ 3) | ||
| Gemcitabine + IMRT (54 Gy, n = 13) | Neutrophil count decreased | 3 (23.1) |
| Anemia | 1 (7.7) | |
| Malaise | 1 (7.7) | |
| Gemcitabine + S1 + IMRT (54 Gy, n = 1) | Any adverse events | 0 |
Table 3 Clinical outcomes of the surgery, n (%)/median (range)
| Outcomes | n = 14 | |
| Surgical procedures | ||
| Pancreatoduodenectomy | 14 (100) | |
| Combination with portal vein resection | 5 (35.7) | |
| Intraoperative characteristics | ||
| Blood loss (mL) | 320 (107-1900) | |
| Operative time (minute) | 460 (249-714) | |
| Intraoperative transfusion | 5 (35.7) | |
| Incidence rate of postoperative complication (≥ CD IIIa) | 4 (28.5) | |
| Pancreatic fistula | 1 (7.1) | |
| Superficial wound infection | 3 (21.4) | |
| Hospital stay (days) | 23 (14-60) | |
| Mortality | 0 | |
| Resection margin, R0 | 14 (100) | |
| Pathological response (Evans grade) | I | 1 (7.1) |
| IIa | 8 (57.1) | |
| IIb | 5 (35.7) | |
| pStage (JPS 8th) | IA | 1 (7.1) |
| IIA | 6 (42.9) | |
| IIB | 7 (50.0) | |
- Citation: Asada S, Kitagawa K, Hanatani J, Motokawa Y, Osaki Y, Iwata T, Kaji K, Mitoro A, Nagai M, Yoshiji H, Sho M. Endoscopic biliary drainage with multi-hole self-expandable metallic stent during neoadjuvant chemoradiotherapy in pancreatic cancer. World J Gastrointest Endosc 2025; 17(11): 111107
- URL: https://www.wjgnet.com/1948-5190/full/v17/i11/111107.htm
- DOI: https://dx.doi.org/10.4253/wjge.v17.i11.111107