Latest advancements in endoscopic palliative care for patients with pancreatic cancer.

Abstract

Pancreatic cancer is a major cause of cancer-related mortality and is frequently diagnosed at advanced stages when surgery is no longer an option. Most patients require palliative care to manage symptoms, such as jaundice, pain, and gastric outlet obstruction (GOO). Therapeutic endoscopic options, including endoscopic ultrasound (EUS)-guided techniques, have become essential for improving quality of life. We conducted a literature review focusing on the current palliative endoscopic therapy options for advanced pancreatic cancer. Malignant biliary obstruction is primarily treated using endoscopic retrograde cholangiopancreatography. However, when this method is complex or unsuccessful, EUS-guided biliary drainage is considered a reliable and safe alternative. Irradiating stents may increase stent patency times and patient survival. EUS-guided gastroenterostomy, if technical expertise is available, is becoming the first option for GOO in patients with longer survival, with enteral stenting being preferred for patients with limited life expectancies or when the EUS option is not available. Although EUS-guided celiac plexus neurolysis and pancreatic duct drainage play a role in pain management, EUS-guided radiofrequency ablation remains under investigation. In conclusion, endoscopic and EUS-guided interventions provide safe, minimally invasive, and highly effective approaches for the palliative care of pancreatic cancer, enhancing patients' quality of life and minimizing the need for more invasive surgical procedures.