Abstract
Painless jaundice is a harbinger of malignant biliary obstruction, with the majority
of cases due to pancreatic adenocarcinoma. Despite advances in treatment, including
improved surgical techniques and neoadjuvant (preoperative) chemotherapy, long-term
survival from pancreatic cancer is rare. This lack of significant improvement in outcomes
is believed to be due to multiple reasons, including the advanced stage at diagnosis
and lack of an adequate biomarker for screening and early detection, prior to the
onset of jaundice or epigastric pain. Close attention is required to select appropriate
patients for preoperative biliary decompression, and to prevent morbid complications
from biliary drainage procedures, such as pancreatitis and cholangitis. Use of small
caliber plastic biliary stents during endoscopic retrograde cholangiopancreatography
should be minimized, as metal stents have increased area for improved bile flow and
a reduced risk of adverse events during neoadjuvant therapy. Efforts are underway
by translational scientists, radiologists, oncologists, surgeons, and gastroenterologists
to augment lifespan for our patients and to more readily treat this deadly disease.
In this review, the authors discuss the rationale and techniques of endoscopic biliary
intervention, mainly focusing on malignant biliary obstruction by pancreatic cancer.
Keywords
malignant biliary obstruction - endoscopic retrograde cholangiopancreatography - endoscopic
ultrasound - surgically altered anatomy - interventional radiology
