Clin Endosc.  2019 May;52(3):226-234. 10.5946/ce.2019.003.

Endoscopic Palliation for Biliary and Pancreatic Malignancies: Recent Advances

• Nabi Z
• Reddy DN

• KMID: 2449761
• DOI: http://doi.org/10.5946/ce.2019.003

Abstract

Malignancies of the pancreatobiliary system are usually unresectable at the time of diagnosis. As a consequence, a majority of these cases are candidates for palliative care. With advances in chemotherapeutic agents and multidisciplinary care, the survival rate in pancreatobiliary malignancies has improved. Therefore, there is a need to provide an effective and long-lasting palliative care for these patients. Endoscopic palliation is preferred to surgery as the former is associated with equal efficacy and reduced morbidity. The main role of endoscopic palliation in the vast majority of pancreatobiliary malignancies includes biliary and enteral stenting for malignant obstructive jaundice and gastric outlet obstruction, respectively. Recent advances in endoscopic palliation appear promising in imparting long-lasting relief of symptoms. Use of radiofrequency ablation and photodynamic therapy in malignant biliary obstruction has been shown to improve the survival rates as well as the patency of biliary stents. The emergence of endoscopic ultrasound (EUS) as a therapeutic tool has enhanced the capability of minimally invasive palliation in pancreatobiliary cancers. EUS is a valuable alternative to endoscopic retrograde cholangiopancreatography for the palliation of obstructive jaundice. More recently, EUS is emerging as an effective primary modality for biliary and gastric bypass.

Keyword

Pancreatic neoplasms; Palliation; Radiofrequency ablation; Endoscopic ultrasound

MeSH Terms

Catheter Ablation
Cholangiopancreatography, Endoscopic Retrograde
Diagnosis
Gastric Bypass
Gastric Outlet Obstruction
Humans
Jaundice, Obstructive
Palliative Care
Pancreatic Neoplasms
Photochemotherapy
Stents
Survival Rate
Ultrasonography