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.