Grant: Project Grant

Pancreatic cancer is one of the leading causes of cancer related deaths in Canada. It has the propensity to invade or compress the bile duct, which is the conduit that allows bile to flow from the liver to the small intestines. Bile duct obstruction leads to symptoms of jaundice (yellowing of the skin), itching of the skin, malnutrition (bile is necessary for fat digestion/absorption), bile duct infection, and liver dysfunction. Without adequate bile flow patients cannot start chemotherapy treatments, which requires adequate liver function. The standard treatment for bile duct obstruction is through an endoscopic procedure called ERCP where a camera is advanced through the patient's mouth to the natural opening of the bile duct. A metal stent (metal tube) can then be inserted to re-establish bile flow. Although effective this procedure is associated with up to 30% need for re-intervention due to stent blockage from tumor growing through the stent. Stent blockage is associated with risk of bile duct infection, re-hospitalization, re-intervention, interruption in chemotherapy treatment, decreased in quality of life, and cost to our health care system. A new modality using endoscopic ultrasound (another type of camera with ultrasound capability) and a novel metal stent allows the placement of the stent above the tumor creating a new tract between the bile duct and gastrointestinal lumen. This "bypass" stent is postulated to minimize the risk for stent obstruction from tumor ingrowth. The goal of our proposed study is to compare this new modality with ERCP. This is a randomized controlled trial (patients will receive one of the treatments at random similar to a "flip of a coin") involving 10 Canadian centres. We believe that the "bypass" stent is more effective with better stent patency leading to better oncological care for patients with pancreatic cancer. The results of our study could potential change our approach to cancer related bile duct obstruction.