International Session（Symposium）6(JSGE・JGES・JSGS・JSGCS)
Fri. November 6th   9:00 - 12:00   Room 11: Portopia Hotel South Wing Topaz
IS-S6-1_G
 New advancement of endoscopic palliative management of pancreatic cancer
Hsiu-Po Wang
National Taiwan University Hospital
Pancreatic cancer (PC) incidence rate has increased over the last decades. The PC is with aggressive course and with poor prognosis. Only 20% of patients are surgical candidates and <10% undergo complete surgical resection. The 5-year overall survival (OS) rate is less than 20%.
The patients with advanced PC are commonly treated with chemoradiotherapy. Additional treatments have been suggested for improving the life-quality, prolonging of life. They include endoscopic ultrasound (EUS) guided local therapy and endoscopic drainage, stenting and bypass.
The local complications of PC include biliary obstruction with and without infection, recurrent pancreatitis due to pancreatic duct obstruction by tumors, and poor intake due to duodenal obstruction. The complications may delay the scheduled chemotherapy of PC. Traditionally, ERCP is undergone for biliary and pancreatic decompensation. And endoluminal stents are placed for duodenal obstruction. However, there are anatomic change due to the progression of PC and the traditional endoscopic approach for the treatment biliary/pancreatic decompensation and endoluminal stenting becomes difficult.
EUS guided procedures has been widely used clinically. For the advanced PC, EUS guided local therapy with thermal ablation (RFA…..) and brachytherapy have proposed. On the other hand, EUS guided procedures can overcome the difficulties of the traditional endoscopic procedures for biliopancreatic decompensation and endoscopic duodenal stenting.
EUS-guided biliary drainage has been used when the access of ampulla is difficult or for primary procedures of drainage suggested by some experts. The EUS guided biliary drainage include choledochoduodenostomy (CDS), hepatogastrostomy (HGS), antegrade procedure and Rendezvous technique. High clinical successful rates have been reported. EUS guided gallbladder drainage is indicated for cholecystitis during the disease course. For the recurrent pancreatitis of the patients with PC, operated or non-operated, EUS guided stent placement is a good option as the EUS guided biliary drainage.
Duodenal obstruction is another local complications causing poor food intake leading to malnutrition and the risk of aspiration. Endoscopic duodenal stenting has been applied clinically but cannot avoid the stent failure due to the tumor overgrowth and ingrowth. Reintervention is common. The EUS guided gastrojejunostomy provides the new route bypassing the tumors. Several studies have proved the technique has equal or higher clinical success rate compared with surgical bypass and endoscopic stent placement.
Palliative care of PC patients is an important issue to improve the life quality and if possible, prolong the survival.
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