Endoscopic palliation for inoperable pancreatic cancer.

BACKGROUND The majority of patients with pancreatic cancer are not candidates for surgical resection. Palliative therapy remains the cornerstone of management of this population. METHODS We reviewed recent clinical and experimental studies on endoscopic palliative therapy of inoperable pancreatic cancer. RESULTS Endoscopic placement of a biliary stent is the preferred mode of palliation of obstructive jaundice in patients with pancreatic cancer. The techniques of endoscopic stent insertion are briefly described. Episodic recurrence of jaundice and cholangitis due to stent occlusion is a major drawback of biliary polyethylene stents. Self-expandable metal stents with large diameters have lower rates of stent occlusion and are cost effective in patients who are expected to survive beyond 3 months. Palliation of duodenal obstruction with self-expandable enteral stents and endosonography-guided celiac plexus neurolysis are emerging options for the treatment of patients with advanced pancreatic cancer. CONCLUSIONS Endoscopic therapy offers safe and effective management options for palliation of major symptoms associated with inoperable pancreatic cancer.