Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy

Abstract

Gallbladder cancer is a rare malignancy burdened by poor prognosis with an estimated 5-year survival of 5% to 13% due to late presentation, early infiltration of surrounding tissues, and lack of successful treatments. The only curative approach is surgery; however, more than 50% of cases are unresectable at the time of diagnosis. Endoscopy represents, together with surgery and chemotherapy, an available palliative option in advanced gallbladder cancers not eligible for curative treatments. Cholangitis, jaundice, gastric outlet obstruction, and pain are common complications of advanced gallbladder cancer that may need endoscopic management in order to improve the overall survival and the patients’ quality of life. Endoscopic biliary drainage is frequently performed to manage cholangitis and jaundice. ERCP is generally the preferred technique allowing the placement of a plastic stent or a self-expandable metal stent depending on the singular clinical case. EUS-guided biliary drainage is an available alternative for patients not amenable to ERCP drainage (e.g., altered anatomy). Gastric outlet obstruction is another rare complication of gallbladder malignancy growing in contact with the duodenal wall and causing its compression. Endoscopy is a less invasive alternative to surgery, offering different options such as an intraluminal self-expandable metal stent or EUS-guided gastroenteroanastomosis. Abdominal pain associated with cancer progression is generally managed with medical treatments; however, for incoercible pain, EUS-guided celiac plexus neurolysis has been described as an effective and safe treatment. Locoregional treatments, such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and intraluminal brachytherapy (IBT), have been described in the control of disease progression; however, their role in daily clinical practice has not been established yet. The aim of this study is to perform a review of the literature in order to assess the role of endoscopy and the available techniques in the palliative therapy of advanced gallbladder malignancy.

Gallbladder Cancer: Current Multimodality Treatment Concepts and Future Directions

“…Beyond radiation therapy, other approaches for local disease control for BTC are investigated in several studies, but these studies do not specifically address a GBC subgroup, and a detailed description is beyond the scope of this review. Furthermore, endoscopic techniques for symptom control and biliary drainage in patients with GBC are described in a current review by Schepis et al and will not be discussed in this article [ 89 ].…”

Matrine inhibits invasion and migration of gallbladder cancer via regulating the PI3K/AKT signaling pathway

“…Due to concealed physiological location of the gallbladder, located on the lower surface of the liver, and the patient's early remediable stage when speci c symptoms are rarely appearance (Vega et al 2022). Therefore, most GBC is typically diagnosed incidentally in tissue specimens after symptomatic gallstone resection at advanced stage (Schepis et al 2022). In addition, the highly invasive behavior and limited treatment options in advanced GBC, resulting in the poor prognosis (Sturm et al 2022).…”

Clinicopathological and Molecular Insights into Gallbladder Cancer

“…The role of endoscopy and currently available techniques in the context of palliative care of advanced gallbladder malignancy were reviewed by Schepis et al [13]. The authors discussed essential recommendations when choosing available EUS procedures, depending on local facilities.…”