Pancreas cancer is a fourth-leading cause of
cancer death in the USA and its incidence is rising as the population is aging. The majority of patients present at an advanced stage due to the silent nature of the disease and treatment have focused more on palliation than curative intent. Gastroenterologists have become integral in the multidisciplinary care of these patients with a focus on providing endoscopic palliation of
pancreas cancer. The three most common areas that gastroenterologists palliate endoscopically are biliary obstruction,
cancer-related pain, and
gastric outlet obstruction. To palliate biliary obstruction, the procedure of choice is to perform endoscopic retrograde cholangiopancreatography (ERCP) with biliary
stent placement. We tend to place covered
self-expandable metal stents (SEMS) due to their longer patency and removability unless the patient has resectable disease.
Pancreas cancer pain is a result of
tumor infiltration of the celiac plexus and can be severe and poorly responsive to
narcotics. To improve
pain control, neurolysis of the celiac plexus has been performed for decades. Since 1996, neurolysis of the celiac area has been performed endoscopically by Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis. This has proven to be as safe and effective as traditional non-endoscopic methods and has allowed the patients to decrease their
narcotic use and improve their
pain control. This should be done early on in the course of the disease to have maximal effect.
Gastric outlet obstruction (GOO) occurs in approximately 15-20% of patients with
pancreas cancer. Endoscopic palliation of GOO can be performed by placing uncovered
metal enteral
stents across the obstruction. This procedure has proven to be very effective in patients who have a short life expectancy (less than two to 6 months) while surgical bypass should be considered for patients with longer life expectancies because it offers better long-term symptom relief. This chapter will review the current literature, latest advancements, and optimal techniques for endoscopic palliation of
pancreatic cancer.