Pancreatic stents for palliation of “Obstructive” pain in pancreatic malignancy

Tham, T. C. K.; Lichtenstein, David R.; Vandervoort, Jo; Wong, R.; Slivka, Adam; Banks, PA; Carr‐Locke, D. L.

doi:10.1016/s0016-5107(97)80565-2

Cited by 1 publication

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“…According to our experiences and others reported in the literature (19)(20)(21)(22)(23)(24) pancreatic stenting may also play a role in pain relief in a subset of patients with pancreatic cancer (approximately 15% of the entire population) selected on a morphological and clinical basis; about 60% of these patients experience complete disappearance of pain and another 20% to 25% are able to reduce significantly the amount of analgesic drugs required ( Table 2). Long term patency of pancreatic stents in this setting has much less importance than in the setting of chronic pancreatitis because of the limited life expectancy of patients with advanced pancreatic cancer.…”

Section: Discussionmentioning

confidence: 68%

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Endoscopic Pancreatic Stenting in Pancreatic Cancer

Costamagna

Alevras

Palladino

et al. 1999

Canadian Journal of Gastroenterology

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Most pancreatic carcinomas are unresectable at the time of diagnosis; therefore, palliative treatment is very often the main concern of clinicians in this setting. The main symptoms resulting in the need for palliation in pancreatic cancer are obstructive jaundice, duodenal obstruction and pain. Therapeutic endoscopy plays a major role in the palliation of obstructive jaundice by stent placement into the biliary ducts. Initial experience has also been gained recently with endoscopic placement of expandable metallic stents to treat gastric outlet obstruction. Much less is known about the possible role of endoscopic pancreatic stenting in patients with unresectable pancreatic carcinoma. The main indication for pancreatic ductal stenting is 'obstructive' pain related to meals in patients with dilated main pancreatic duct beyond the stricture and intraluminal brachyradiotherapy. The technique of endoscopic pancreatic stenting does not substantially differ from that applied on the biliary tree. When technically possible, placement of 10 French plastic stents is preferred. According to the authors' indications, only about 15% of patients with advanced pancreatic cancer (55 of 355 in the present study) may potentially benefit from this technique. Pancreatic stenting may be obtained in more than 80% of these selected patients, with low morbidity (less than 10%) and no procedure-related mortality. According to the authors of the present and other studies reported in the literature, about 60% of patients treated because of 'obstructive' pain become symptom-free, and another 20% to 25% significantly reduce the amount of analgesic drugs required. Intraluminal brachyradiotherapy with 192iridium in the main pancreatic duct is a feasible and safe method to deliver high radiation doses to the tumour while sparing adjacent organs. Brachyradiotherapy may be performed alone or in conjunction with external beam radiotherapy. Because of the small number of patients suitable for this treatment, only a multicentre study will be able to detect whether intraluminal brachyradiotherapy in pancreatic cancer may have any positive impact on survival.

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Section: Discussionmentioning

confidence: 68%

“…In patients with advanced pancreatic cancer, selected on the basis of concomitant 'obstructive' pain and MPD dilation, the aim of endoscopic insertion of a stent across the pancreatic stricture is the decompression of the ductal system to avoid ductal hypertension (19)(20)(21)(22)(23)(24).…”

Section: Indications Of Endoscopic Pancreatic Drainage In Pancreatic mentioning

confidence: 99%