Endoscopic palliation of biliary obstruction

Aadam, A. Aziz; Liu, Kevin

doi:10.1002/jso.25483

Cited by 14 publications

(6 citation statements)

References 59 publications

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“…This method manages to combine the theoretical advantages of enteral stenting and surgery, using a minimally invasive technique to create a large gastrointestinal anastomosis at a distance from the primary tumor [ 11 , 12 ]. As widely proven, EUS-GE is a minimally invasive and cost-effective intervention, beneficial for patient’s QoL [ 13 ]. Some papers focused on the effective role of endoscopic approaches on patients with advanced gastrointestinal tumors [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Mini-Invasive Approaches for Nausea and Vomiting Refractory to Medical Therapy in Palliative Care Setting: A Case Report

Casadio,

Tassinari,

Carloni

et al. 2024

Case Rep Oncol

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Introduction: Nausea and vomiting are frequent multifactorial symptoms in oncological patients. These manifestations, mainly affecting the advanced disease stages, may lead to existential, psychological, and physical suffering, with a negative impact on the quality of life (QoL) of the individual and his family. The medical approach makes use of a wide range of drugs, with different antiemetic potency and various mechanisms of action, taking into account the etiology and the patient’s response to the different therapeutic strategies. In recent years, in addition to pharmacological treatments, some endoscopic procedures have been integrated into clinical practice as promising palliative approaches. Case Presentation: Herein, we describe and discuss a case of a 64-year-old female affected by advanced stage pancreatic adenocarcinoma, in which different techniques – both medical and endoscopic – have been used to approach a refractory symptomatology with a negative impact on the patient’s QoL. In the context of a multidisciplinary approach in primary palliative care, a tailored intervention encompassing invasive methods for palliative purposes, may be considered adequate and appropriate when the prognostic expectation and the physical functionality indices allow it. Conclusion: Minimally invasive palliative interventions should be offered to patients with advanced cancer when symptoms become refractory to standard medical therapies, as part of the holistic approach in modern treatments. Therefore, the integration of an early palliative approach into the patient’s therapeutic path becomes essential for the management of all the individual’s needs.

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Section: Discussionmentioning

confidence: 99%

Appropriateness of Mini-Invasive Approaches for Nausea and Vomiting Refractory to Medical Therapy in Palliative Care Setting: A Case Report

Casadio,

Tassinari,

Carloni

et al. 2024

Case Rep Oncol

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“…Because of anatomical alteration associated with tumor invasion or previous surgery, endoscopic access to the bile duct can be difficult in patients with distal MBO [15,16,27]. In a study of patients with distal MBO due to pancreatic head cancer, adequate drainage was successful in 75% of the cases in the first ERCP trial [28].…”

Section: Discussionmentioning

confidence: 99%

“…According to a recent study of patients with acute cholangitis by Parikh et al [14] MBO is associated with a higher risk of readmission within 30 days. MBO is often combined with anatomical alteration in the gastrointestinal tract, which can make insertion and cannulation difficult [15,16]. The stage of cancer also affects the prognosis.…”

Section: Introductionmentioning

confidence: 99%

Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

et al. 2021

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Background There is a lack of studies regarding the optimal timing for endoscopic retrograde cholangiopancreatography (ERCP) in patients with cholangitis caused by distal malignant biliary obstruction (MBO). This study aims to investigate the optimal timing of ERCP in patients with acute cholangitis associated with distal MBO with a naïve papilla. Methods A total of 421 patients with acute cholangitis, associated with distal MBO, were enrolled for this study. An urgent ERCP was defined as being an ERCP performed within 24 h following emergency room (ER) arrival, and early ERCP was defined as an ERCP performed between 24 and 48 h following ER arrival. We evaluated both 30-day and 180-day mortality as primary outcomes, according to the timing of the ERCP. Results The urgent ERCP group showed the lowest 30-day mortality rate (2.2%), as compared to the early and delayed ERCP groups (4.3% and 13.5%) (P < 0.001). The 180-day mortality rate was lowest in the urgent ERCP group, followed by early ERCP and delayed ERCP groups (39.4%, 44.8%, 60.8%; P = 0.006). A subgroup analysis showed that in both the primary distal MBO group, as well as in the moderate-to-severe cholangitis group, the urgent ERCP had significantly improved in both 30-day and 180-day mortality rates. However, in the secondary MBO and mild cholangitis groups, the difference in mortality rate between urgent, early, and delayed ERCP groups was not significant. Conclusions In patients with acute cholangitis associated with distal MBO, urgent ERCP might be helpful in improving the prognosis, especially in patients with primary distal MBO or moderate-to-severe cholangitis.

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“…Pancreatic enzyme‐replacement therapy helps to stabilize weight loss and also improves QOL by decreasing gastrointestinal symptoms 276‐278 . Malabsorption also occurs because of biliary obstruction, a complication found in up to 90% of patients with PDAC 279,280 . Similar to the replacement of pancreatic enzymes, the treatment of biliary obstruction improves symptoms beyond its effects on digestion, including anorexia, pruritus, and fatigue 281,282 .…”

Section: Survivorship and Patient Resiliencementioning

confidence: 99%

Multidisciplinary standards of care and recent progress in pancreatic ductal adenocarcinoma

Grossberg

Chu

Deig

et al. 2020

CA A Cancer J Clinicians

324

225

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Despite tremendous gains in the molecular understanding of exocrine pancreatic cancer, the prognosis for this disease remains very poor, largely because of delayed disease detection and limited effectiveness of systemic therapies. Both incidence rates and mortality rates for pancreatic cancer have increased during the past decade, in contrast to most other solid tumor types. Recent improvements in multimodality care have substantially improved overall survival, local control, and metastasis-free survival for patients who have localized tumors that are amenable to surgical resection. The widening gap in prognosis between patients with resectable and unresectable or metastatic disease reinforces the importance of detecting pancreatic cancer sooner to improve outcomes. Furthermore, the developing use of therapies that target tumor-specific molecular vulnerabilities may offer improved disease control for patients with advanced disease. Finally, the substantial morbidity associated with pancreatic cancer, including wasting, fatigue, and pain, remains an under-addressed component of this disease, which powerfully affects quality of life and limits tolerance to aggressive therapies. In this article, the authors review the current multidisciplinary standards of care in pancreatic cancer with a focus on emerging concepts in pancreatic cancer detection, precision therapy, and survivorship.

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Endoscopic palliation of biliary obstruction

Cited by 14 publications

References 59 publications

Appropriateness of Mini-Invasive Approaches for Nausea and Vomiting Refractory to Medical Therapy in Palliative Care Setting: A Case Report

Appropriateness of Mini-Invasive Approaches for Nausea and Vomiting Refractory to Medical Therapy in Palliative Care Setting: A Case Report

Optimal timing of endoscopic retrograde cholangiopancreatography for acute cholangitis associated with distal malignant biliary obstruction

Multidisciplinary standards of care and recent progress in pancreatic ductal adenocarcinoma

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