Endoscopic Management of Pancreatobiliary Malignancies

Endoscopic palliation of malignant biliary obstruction

“…PDT utilizes a photosensitizing agent (which is activated by laser light) to ablate tumor tissue via apoptosis, necrosis, and an immunomodulatory effect[ 105 ]. The porphyrin phototoxic substance is given intravenously 3-4 d prior to the procedure to allow for preferential accumulation in the malignant tissue-during this period patients are advised to stay in a darkened room to avoid an accidental inflammatory reaction in normal tissue if exposed to light[ 106 , 107 ]. Next a guidewire and catheter position the fiberoptic probe in the bile duct where laser light at certain wavelengths (typically 630 nm) trigger the photosensitizing agent for 750 sec to generate free oxygen radicals that destroy the tumor bed and/or stricture[ 106 , 108 , 109 ].…”

“…With more wide spread use, developments of newly automatic temperature controlled RFA systems[ 139 ] and endoluminal devices[ 140 ] have produced favorable results pertaining to both stent patency and survival. Interestingly, RFA appears to be a relatively safe procedure with few instances of cholecystitis (10%), cholangitis (6.2%), and pancreatitis (2.1%) that did no differ significantly when compared to stenting alone[ 107 , 136 ].…”

Role of Endoscopy in Management of Upper Gastrointestinal Cancers

“…Some studies also report that early CPN may reduce opioid use or delay dose escalation [ 126 , 127 ], although the findings have been mixed [ 128 ]. Additionally, EUS-guided CPN has not been shown to improve mortality, may be less efficacious when the cancer invades the celiac plexus, and can rarely result in serious complications such as paraplegia [ 127 , 129 , 130 ]. Further studies are needed to elucidate the role of CPN in the palliative management of pain associated with non-pancreatic upper gastrointestinal cancers.…”