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.
Highlights
Pancreatic adenocarcinoma is the fourth leading cause of cancer-related mortality in the U.S and seventh most common in Europe, due to vascular invasion or metastasis at the time of diagnosis [1,2,3].The median survival is less than six months and only a minority (10–20%) of patients are considered candidates for resection at time of diagnosis
Insertion of a biliary endoprosthesis is performed via endoscopic retrograde cholangiopancreatogram (ERCP) where selective cannulation of the bile duct achieved via a catheter and over a guidewire, a stent is typically advanced through a tight stricture, and deployed across the ampulla and into the duodenum
A meta-analysis comparing plastic to metal biliary stents demonstrated no statistical difference in technical success, therapeutic success, complications, or 30 day mortality but did show a lower risk of biliary obstruction for the latter [26]
Summary
Pancreatic adenocarcinoma is the fourth leading cause of cancer-related mortality in the U.S and seventh most common in Europe, due to vascular invasion or metastasis at the time of diagnosis [1,2,3]. Laparoscopic staging to determine resectability and prevent unnecessary exploratory laparotomies has had low detection rates and has fallen out of favor [4]. Even with those that are selected for surgical resection, the five year survival continues to be at 15–20%, primarily due to recurrence [5]. Given this poor prognosis, palliation may be the only option and is targeted at the multiple complications that can occur with pancreatic cancer. Endoscopic techniques have gained favor recently and considered first line treatment due to their lower complication rate and associated shorter hospital stay [9,10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
