Clinical significance of portal venous metallic stent placement in recurrent periampullary cancers.

BACKGROUND/AIMS: We evaluate the clinical significance of portal venous expandable metallic stent (EMS) placement for patients who have malignant portal hypertension caused by recurrent periampullary cancer.

METHODOLOGY

Four post-pancreatoduodenectomy patients underwent percutaneous transhepatic portal venous EMS placement because of symptoms of malignant portal hypertension: intractable ascites (2/4), growth of abnormal collateral vein (3/4), melena (2/4), gastroesophageal varix (3/4) and thrombocytopenia (2/4). They were diagnosed with having a recurrence by cytology of ascitis, computed tomography and/or tumor markers in serum. The stenosis segment was measured by percutaneous-transhepatic portography and was dilated with a balloon prestent placement. The patency of stent was confirmed using Doppler ultrasonography and enhanced computed tomography at least once a month.

RESULTS

The portal venous pressure was significantly decreased from (24.5 +/- 3.92 mmH2O) to (19.5 +/- 3.87 mmH2O) and the symptoms related to portal hypertension were reduced in all patients. There were no complications related to EMS placement. All patients were alive more than a year later and two of four patients were alive more than two years without morbidity.

CONCLUSIONS

Percutaneous-transhepatic portal EMS placement is a minimally invasive procedure and is a useful treatment against malignant portal hypertension caused by recurrent periampullary cancer.