Endoscopic Palliation for Pancreatic Cancer

Abstract

Pancreatic cancer is devastating due to its poor prognosis. Patients require a multidisciplinary approach to guide available options, mostly palliative because of advanced disease at presentation. Palliation including relief of biliary obstruction, gastric outlet obstruction, and cancer-related pain has become the focus in patients whose cancer is determined to be unresectable. Endoscopic stenting for biliary obstruction is an option for drainage to avoid the complications including jaundice, pruritus, infection, liver dysfunction and eventually failure. Enteral stents can relieve gastric obstruction and allow patients to resume oral intake. Pain is difficult to treat in cancer patients and endoscopic procedures such as pancreatic stenting and celiac plexus neurolysis can provide relief. The objective of endoscopic palliation is to primarily address symptoms as well improve quality of life.

Interventional Treatment Methods, Fluorescent Diagnostic and Photodynamic Therapy of Nonresectable Cholangiocarcinoma Complicated by Jaundice

“…Наиболее предпочтительным вариантом чрескожного желчеотведения с точки зрения качества жизни пациента является стентирование желчных протоков [6,14]. Однако, большой проблемой является прорастание опухолью непокрытого стента или распространение опухолевой инфильтрации за его границы.…”

“…Однако, большой проблемой является прорастание опухолью непокрытого стента или распространение опухолевой инфильтрации за его границы. Это приводит к повторной механической желтухе [6,9,23]. В подобной ситуации способы воздействия непосредственно на опухоль с целью стабилизации процесса или хотя бы замедления прогрессирования в настоящее время ограничены.…”

Diagnostic and therapeutic recommendations in pancreatic ductal adenocarcinoma. Recommendations of the Working Group of the Polish Pancreatic Club

“…Duodenal occlusion occurs in about 10–25% of pancreatic cancer patients and is caused by an infiltration of the coeliac plexus and impaired motoric activity of the stomach and duodenum, tumour pressure or direct duodenum infiltration [101, 132–134].…”

“…Endoscopic procedures are characterized by high therapeutic effectiveness, a low morbidity rate and low costs in comparison to surgical methods [134]. Biliary tract occlusion, requiring percutaneous or endoscopic drainage in 40% of patients, is a common problem, occurring during the procedure of duodenal stenting [132, 135]. One way of avoiding this complication is placing a stent in the main biliary duct before duodenal stenting [136].…”

Indications for ERCP

“…Biliary decompression can palliate the consequences of obstruction including jaundice, weight loss, cholangitis, secondary cirrhosis, and pruritus thus improving quality of life. Biliary stent therapy, however, has not been shown to have significant survival benefit [23,24]. Although short-term preoperative biliary drainage with plastic stents is not indicated, metal stents may be cost-effective and, in the potentially resectable patient and/or those undergoing neoadjuvant chemoradiation therapy who have a significant delay between diagnosis and surgery, metal stent placement is indicated.…”