Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer
Abstract Pancreatic cancer is among the leading causes of gastrointestinal cancer‐related death, with a dismal prognosis. Over 80% of pancreatic cancer patients present with advanced disease, making curative resection unfeasible. These patients are often presented with malignant biliary obstruction...
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Wiley
2025-03-01
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| Series: | Annals of Gastroenterological Surgery |
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| Online Access: | https://doi.org/10.1002/ags3.12902 |
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| author | Pengfei Wu Kai Chen Jin He |
| author_facet | Pengfei Wu Kai Chen Jin He |
| author_sort | Pengfei Wu |
| collection | DOAJ |
| description | Abstract Pancreatic cancer is among the leading causes of gastrointestinal cancer‐related death, with a dismal prognosis. Over 80% of pancreatic cancer patients present with advanced disease, making curative resection unfeasible. These patients are often presented with malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). In these cases, palliative management is aimed to alleviate symptoms, enhance quality of life, and facilitate subsequent chemotherapy. Currently, neoadjuvant chemotherapy is frequently used in both borderline resectable and resectable pancreatic cancer, necessitating effective biliary and gastrointestinal drainage in a growing number of patients. Traditionally, surgical bypass was the gold standard, performed via either a minimally invasive or open approach. However, notable progress has emerged in developing endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP) stenting for MBO and endoscopic enteral stenting for GOO. While these procedures provide rapid symptom relief, they are associated with higher stent dysfunction rates and more frequent re‐intervention needs. When ERCP fails, percutaneous transhepatic biliary drainage is a widely accepted alternative for MBO. Endoscopic ultrasound (EUS)‐guided techniques, including EUS‐guided biliary drainage and EUS‐guided gastroenterostomy, have recently gained prominence. Emerging clinical data suggest that these methods may be superior, potentially becoming the preferred first‐line palliative treatment for unresectable pancreatic cancer. This review will summarize the current evidence on managing MBO and GOO in patients with pancreatic cancer. |
| format | Article |
| id | doaj-art-0270fb3b1f744e38afb2e1a5e9280f0b |
| institution | OA Journals |
| issn | 2475-0328 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj-art-0270fb3b1f744e38afb2e1a5e9280f0b2025-08-20T02:02:09ZengWileyAnnals of Gastroenterological Surgery2475-03282025-03-019221822510.1002/ags3.12902Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancerPengfei Wu0Kai Chen1Jin He2Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USADepartment of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USAAbstract Pancreatic cancer is among the leading causes of gastrointestinal cancer‐related death, with a dismal prognosis. Over 80% of pancreatic cancer patients present with advanced disease, making curative resection unfeasible. These patients are often presented with malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). In these cases, palliative management is aimed to alleviate symptoms, enhance quality of life, and facilitate subsequent chemotherapy. Currently, neoadjuvant chemotherapy is frequently used in both borderline resectable and resectable pancreatic cancer, necessitating effective biliary and gastrointestinal drainage in a growing number of patients. Traditionally, surgical bypass was the gold standard, performed via either a minimally invasive or open approach. However, notable progress has emerged in developing endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP) stenting for MBO and endoscopic enteral stenting for GOO. While these procedures provide rapid symptom relief, they are associated with higher stent dysfunction rates and more frequent re‐intervention needs. When ERCP fails, percutaneous transhepatic biliary drainage is a widely accepted alternative for MBO. Endoscopic ultrasound (EUS)‐guided techniques, including EUS‐guided biliary drainage and EUS‐guided gastroenterostomy, have recently gained prominence. Emerging clinical data suggest that these methods may be superior, potentially becoming the preferred first‐line palliative treatment for unresectable pancreatic cancer. This review will summarize the current evidence on managing MBO and GOO in patients with pancreatic cancer.https://doi.org/10.1002/ags3.12902biliary tractdrainagegastric outletobstructionpancreatic neoplasms |
| spellingShingle | Pengfei Wu Kai Chen Jin He Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer Annals of Gastroenterological Surgery biliary tract drainage gastric outlet obstruction pancreatic neoplasms |
| title | Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer |
| title_full | Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer |
| title_fullStr | Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer |
| title_full_unstemmed | Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer |
| title_short | Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer |
| title_sort | palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer |
| topic | biliary tract drainage gastric outlet obstruction pancreatic neoplasms |
| url | https://doi.org/10.1002/ags3.12902 |
| work_keys_str_mv | AT pengfeiwu palliativemanagementformalignantbiliaryobstructionandgastricoutletobstructionfrompancreaticcancer AT kaichen palliativemanagementformalignantbiliaryobstructionandgastricoutletobstructionfrompancreaticcancer AT jinhe palliativemanagementformalignantbiliaryobstructionandgastricoutletobstructionfrompancreaticcancer |