2023 Volume 65 Issue 4 Pages 368-374
A 65-year-old male presented with abdominal distension, and laboratory data showed elevated hepatobiliary enzymes. Contrast-enhanced computed tomography revealed a pancreatic tumor with 10 mm in diameter in the pancreatic head, resulting in biliary obstruction. Endoscopic retrograde cholangiopancreatography showed a 10-mm long stricture in the lower bile duct. Biopsy of the stenosis confirmed pancreatic adenocarcinoma and administration of chemotherapy was planned. A self-expandable metallic stent (SEMS) was placed in the bile duct, but the patient developed recurrent reflux cholangitis. Although the cholangitis was refractory to the treatment, it eventually improved with the replacement of SEMS with duckbill-shaped anti-reflux metallic stent (D-ARMS), enabling chemotherapy initiation.
Although SEMS are effective for malignant distal biliary strictures, reflux cholangitis due to SEMS is one of the causes of delay in the timely initiation of chemotherapy or surgery. Newer types of SEMS with anti-reflux valves (anti-reflux metallic stent, ARMS) have been developed, and previous studies have been conducted mainly to evaluate the time taken until the obstruction. However, there have been no studies demonstrating the efficacy in actually preventing reflux cholangitis. Herein, we experienced a case of refractory reflux cholangitis caused by SEMS placed in a patient with obstructive jaundice due to pancreatic head cancer, which improved after replacement with D-ARMS. Although the frequency of reflux cholangitis after SEMS placement is low, the growing trend for neoadjuvant chemotherapy for pancreatic cancer may increase its incidence. In the future, it is expected that more cases at risk for reflux cholangitis will be identified and the usefulness of ARMS for treating reflux cholangitis will be further evaluated.
