Endoscopic Management of Pancreatic Cancer: From Diagnosis to Palliative Therapy

Endoscopic Treatment of Pancreatic Diseases

“…Most cases with PC are diagnosed at an advanced stage when surgical resection is not possible. Patients with unresectable PC often develop biliary and/or duodenal obstruction during the course of their disease, which are related with various complications and negative impact on quality of life, and not rarely are a cause for discontinuation of chemotherapy [214,215]. In the past, surgical bypasses (biliary-digestive and gastro-jejunal anastomoses) were used for palliative treatment of biliary or duodenal obstruction, but currently endoscopic stenting is the preferred method.…”

“…Pain is reported in the majority of patients with advanced pancreatic cancer (90%) and its palliation is often difficult [215]. About 15% of patients with inoperable PC, having dilated main pancreatic beyond the stricture and an "obstructive" pain related to meals, may potentially benefit from endoscopic pancreatic stenting [236].…”

“…Endoscopic treatment of duodenal stenosis, due to invasion of PC, includes placement of an SEMS through the duodenoscope (Figure 4) [214,215,234]. The reported success rate is 92%-100% and rapid alimentary recovery (usually within 24 h) occurs in 75%-93% of cases [217].…”

“…Brachytherapy is a useful method for local control of various malignant tumors, including pancreas [48,215]. The placement of radioactive seeds allows steady radiation, leading to localized ablation and avoiding the radiation of normal tissues surrounding the malignant lesion.…”

“…Insertion of SEMS was advised in cases with biliary SEMS occlusion, as it provided longer patency and survival and decreased the number of subsequent procedures by 50% (compared to plastic stents) [229]. Technical failure during ERCP is encountered in up to 10% of cases due to various factors (duodenal obstruction, anatomical variations, periampullary diverticulum, tightness of the stricture) [214,215]. In these cases, percutaneous transhepatic biliary drainage (PTBD), EUS-guided biliary drainage (BD), and surgical drainage are possible alternatives.…”