Clinical Endoscopy

Review

Latest advancements in endoscopic palliative care for patients with pancreatic cancer: Raquel Gonçalves, Joel Silva, Eduardo Rodrigues-Pinto; Received July 10, 2025 Accepted August 26, 2025 Published online April 28, 2026; DOI: https://doi.org/10.5946/ce.2025.227 [Epub ahead of print]

Abstract PDF PubReader ePub: 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.

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Case Reports

Early Lumen-Apposing Metal Stent Dysfunction Complicating Endoscopic Ultrasound-Guided Gastroenterostomy: A Report of Two Cases: Janine B. Kastelijn, Veronique Van der Voort, Alderina Bijlsma, Leon M. G. Moons, Matthijs P. Schwartz, Frank P. Vleggaar; Clin Endosc 2021;54(4):603-607. Published online January 13, 2021; DOI: https://doi.org/10.5946/ce.2020.201

Abstract PDF PubReader ePub

Endoscopic ultrasonography-guided gastroenterostomy using a lumen-apposing metal stent has emerged as a novel technique in the palliative treatment of malignant gastric outlet obstruction. Endoscopic ultrasonography-guided gastroenterostomy seems to have the potential to provide long-lasting patency in a minimally invasive manner. Low reintervention rates have been described. We report two cases with early lumen-apposing metal stent dysfunction, compromising patency. One case showed food impaction after three weeks, and hyperplastic tissue overgrowth with a buried distal flange six weeks after stent placement. The latter was successfully treated by argon plasma coagulation, stent removal, and deployment of a larger-diameter lumen-apposing metal stent. The second case showed a narrowed luminal diameter of the stent and jejunal pressure ulcerations after three weeks. The narrowing was successfully treated by balloon dilation. Eight weeks later, hyperplastic tissue overgrowth at the distal flange of the stent and a gastro-colonic fistula were diagnosed, followed by extensive reconstructive surgery.

Citations

Citations to this article as recorded by

International Consensus Recommendations for Safe Use of LAMS for On- and Off-Label Indications Using a Modified Delphi Process
Sebastian Stefanovic, Douglas G. Adler, Alexander Arlt, Todd H. Baron, Kenneth F. Binmoeller, Michiel Bronswijk, Marco J. Bruno, Jean-Baptiste Chevaux, Stefano Francesco Crinò, Helena Degroote, Pierre H. Deprez, Peter V. Draganov, Pierre Eisendrath, Marc
American Journal of Gastroenterology.2024; 119(4): 671. CrossRef
Therapeutic endoscopic ultrasound: European Society of Gastrointestinal Endoscopy (ESGE) Guideline
Schalk W. van der Merwe, Roy L. J. van Wanrooij, Michiel Bronswijk, Simon Everett, Sundeep Lakhtakia, Mihai Rimbas, Tomas Hucl, Rastislav Kunda, Abdenor Badaoui, Ryan Law, Paolo G. Arcidiacono, Alberto Larghi, Marc Giovannini, Mouen A. Khashab, Kenneth F.
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Metal Stent Placement in the Afferent Loop Obstructed by Peritoneal Metastases—Experience of Five Cases: Yoshihide Kanno, Tetsuya Ohira, Yoshihiro Harada, Yoshiki Koike, Taku Yamagata, Megumi Tanaka, Tomohiro Shimada, Kei Ito; Clin Endosc 2018;51(3):299-303. Published online April 18, 2018; DOI: https://doi.org/10.5946/ce.2018.005

Abstract PDF PubReader ePub

Afferent loop syndrome is often difficult to resolve. Among patients with afferent loop syndrome whose data were extracted from databases, 5 patients in whom metal stent placement was attempted were included and evaluated in this study. The procedure was technically successful without any adverse events in all patients. Metal stent(s) was placed with an endoscope in the through-the-scope manner in 4 patients and via a percutaneous route in 1 patient. Obvious clinical efficacy was observed in all patients. Adverse events related to the procedure and stent occlusion during the follow-up period were not observed. Metal stent placement for malignant obstruction of the afferent loop was found to be safe and feasible.

Citations

Citations to this article as recorded by

Early and late effects of endoscopic interventions in patients with malignant afferent loop syndrome: A single‐center experience and literature review
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Journal of Hepato-Biliary-Pancreatic Sciences.2024; 31(2): 120. CrossRef
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Endoscopic Transluminal Stent Placement for Malignant Afferent Loop Obstruction
Chinatsu Yonekura, Takashi Sasaki, Takafumi Mie, Takeshi Okamoto, Tsuyoshi Takeda, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
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World Journal of Gastrointestinal Oncology.2021; 13(7): 684. CrossRef
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Arata Sakai, Hideyuki Shiomi, Takao Iemoto, Ryota Nakano, Takuya Ikegawa, Takashi Kobayashi, Atsuhiro Masuda, Yuzo Kodama
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Yuning Cao, Xiangheng Kong, Daogui Yang, Senlin Li
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8,057 View
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10 Web of Science
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