Endoscopic Palliation of Pancreatic Cancer.
Endoscopic Palliation of Pancreatic Cancer.
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DOI：
10.1007/s11938-017-0145-z
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发表时间：
2017-09-01
期刊：
影响因子：
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通讯作者：
Klapman, Jason B
中科院分区：
文献类型：
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作者：
Gohil, Vishal B;Klapman, Jason B
观点声明：胰腺癌是美国癌症死亡的第四大原因，随着人口老龄化，其发病率正在上升。由于疾病的无症状性质，大多数晚期患者的治疗更侧重于缓解而不是治疗目的。胃肠病学家已经成为这些患者的多学科护理中不可或缺的一部分，重点是提供胰腺癌的内镜姑息治疗。胃肠病学家通过内镜缓解的三个最常见的区域是胆道梗阻、癌症相关疼痛和胃出口梗阻。为了减轻胆道梗阻，选择的手术是进行内镜逆行胰胆管造影（ERCP）和胆道支架置入术。我们倾向于放置覆膜自膨式金属支架（SEMS），因为它们的通畅性和可移除性更长，除非患者患有可切除的疾病。胰腺癌疼痛是肿瘤浸润腹腔神经丛的结果，并且可能是严重的并且对麻醉剂反应不良。为了改善疼痛控制，腹腔神经丛的神经松解术已经进行了几十年。自1996年以来，腹腔区域的神经松解术已经通过内窥镜超声引导腹腔神经丛神经松解术在内窥镜下进行。这已被证明与传统的非内窥镜方法一样安全有效，并允许患者减少麻醉剂的使用并改善疼痛控制。这应该在疾病的早期进行，以获得最大的效果。胃出口梗阻（GOO）发生在约15-20%的胰腺癌患者中。内镜下姑息GOO可以通过放置无覆盖的金属肠内支架穿过梗阻来进行。这种手术已被证明是非常有效的病人谁有一个短的预期寿命（少于2至6个月），而手术旁路应考虑为患者较长的预期寿命，因为它提供了更好的长期症状缓解。本章将回顾目前的文献，最新进展，和最佳的技术内镜姑息胰腺癌。
OPINION STATEMENT: 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 6months) 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.