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Korean J Gastroenterol  <  Volume 74(2); 2019 <  Articles

Korean J Gastroenterol 2019; 74(2): 69-80  https://doi.org/10.4166/kjg.2019.74.2.69
Relief of Obstruction in the Management of Pancreatic Cancer
Chang-Il Kwon
Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
Correspondence to: Chang-Il Kwon, Digestive Disease Center, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam 13496, Korea. Tel: +82-31-780-5641, Fax: +82-31-780-5219, E-mail: endoscopy@cha.ac.kr, ORCID: https://orcid.org/0000-0003-3621-9023
Received: June 15, 2019; Revised: July 1, 2019; Accepted: July 5, 2019; Published online: August 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Pancreatic cancer is a major cause of cancer-related mortality and morbidity, and its incidence is increasing as the population is aging. On the other hand, significant improvement in the prognosis has not occurred. The absence of early diagnosis means that many patients are diagnosed only when they develop symptoms, such as jaundice, due to a biliary obstruction. The role of endoscopy in multidisciplinary care for patients with pancreatic cancer continues to evolve. Controversy remains regarding the best preoperative biliary drainage in patients with surgically resectable pancreatic head cancer. In general, patients undergoing a surgical resection usually do not require preoperative biliary drainage unless they have cholangitis or receive neoadjuvant chemotherapy. If biliary drainage is performed prior to surgery, the patient’s condition and a multidisciplinary approach should be considered. With the increasing life expectancy of patients with pancreatic cancer, the need for more long-time biliary drainage or pre-operative biliary drainage is also increasing. Strong evidence of endoscopic retrograde cholangiopancreatography (ERCP) as a first-line and essential treatment for biliary decompression has been provided. On the other hand, the use of endoscopic ultrasound-guided biliary drainage as well as percutaneous biliary drainage has been also recommended. During ERCP, self-expandable metal stent could be recommended instead of a plastic stent for the purpose of long stent patency and minimizing stent-induced complications. In this review, several points of view regarding the relief of obstruction in patients with pancreatic cancer, and optimal techniques are being discussed.
Keywords: Pancreatic neoplasms; Stents; Endoscopy; Biliary obstruction; Cholangiopancreatography, endoscopic retrograde


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