Efficacy of Endoscopic Biliary Drainage in Pancreatic Adenocarcinoma

Abstract

Introduction: The incidence of pancreatic cancer has increased in recent years. Pancreatic cancer accounts for 2.9% of all cancers in our registry. Biliary drainage is frequently required and is mainly indicated in cases of cholangitis and/or hyperbilirubinemia. Our work aimed to evaluate the efficacy of endoscopic biliary drainage in pancreatic adenocarcinoma. Materials and Methods: A cross-sectional study was conducted between May 2019 and October2021 and included all patients with pancreatic adenocarcinoma, who underwent endoscopic biliary drainage. Results: Forty-five patients were enrolled, including 23 males and 22 females with a sex ratio of 1.04. The average age was 61 ± 10.9 years. Seven patients (16%) had a history of diabetes, 7 patients (16%) had a history of smoking, 4 patients (9%) had a history of alcoholism, 27 patients had no history. All patients were presented with cholestatic jaundice and 17 patients (37.7%) with abdominal pain. After morphological evaluation, only 11% of our patients had a resect able tumor and 89% of the patients had an unresectable tumor. Thirty-eight patients (84%) had a metallic biliary stent and seven patients (16%) had a plastic biliary stent. Biliary drainage associated with antibiotic therapy allowed controlling cholangitis in 98% of cases, only one patient (2%) died after drainage from sepsis. The average total bilirubin level before biliary drainage was 19.7 mg/dl and 4.8 mg/dl 2 weeks after drainage (P = 0.51), representing a decrease of 76%. Conclusion: Endoscopic biliary drainage is the gold standard for relieving the obstruction in pancreatic adenocarcinoma. Most of our patients (89%) had an unresectable pancreatic tumor. Drainage was ensured respectively by the metallic stent and plastic stent in 84% and 16% of patients and provided very sufficient biliary drainage with a decrease of 76% of bilirubinemia at 2 weeks post drainage.