Sa1441 A Single Center Retrospective Review of ERCP Stent Practice Patterns in the Era of Irreversible Electroporation for Locally Advanced Pancreatic Cancer

Pancreatic cancer remains a challenging entity as the diagnosis is often made when curative surgery is not initially possible. Traditional therapy for advanced disease (stage III/IV) can involve multiple modalities including chemotherapy and radiation. Irreversible electroporation (IRE) is a novel therapy geared towards locally advanced stage III pancreatic adenocarcinoma usually in the pancreatic head, body or neck. IRE is a non-thermal ablative therapy introducing microscopic perforations of the cell membrane with resultant cell death. When the probes are appropriately positioned the malignant target is affected without injury to neighboring cartilagenous structures such as vessels or the bile duct. Image distortion from metal biliary stents prevents effective IRE treatment. Many patients with pancreatic cancer will require stent placement and some guidelines have advocated for metal stent placement in both unresectable diesase to decrease unnecessary procedures or in resectable disease as a bridge to surgery. However, if pre-ERCP clinical staging is not accurate some patients who may benefit from IRE therapy would not be available to obtain the treatment, unless efforts are made to remove an uncovered metal stent which can itself be challenging. At our institution 14 patients were being evaluated for IRE. 78.6% (11/14) have had the IRE procedure performed and of those 18.2% (2/11) required successful exchange of a fully covered SEMS stent to a plastic stent. The other 9 patients either had plastic stents or no stent at all and no stent exchange was required. Three patients have uncovered SEMS which have not been successfully removed and exchanged to a plastic stent. IRE is not standard of care therapy for stage III pancreatic adenocarcinoma but offers another treatment paradigm for the disease. ERCP practitioners should consider placement of plastic or fully covered SEMS for stage III pancreatic disease or have facility with the challenges of uncovered SEMS removal.