Published online Oct 16, 2020. doi: 10.4253/wjge.v12.i10.323
Peer-review started: June 16, 2020
First decision: July 21, 2020
Revised: July 23, 2020
Accepted: September 22, 2020
Article in press: September 22, 2020
Published online: October 16, 2020
Pancreatic cancer is the leading cause of cancer-related morbidity and mortality with an overall five-year survival of less than 9% in the United States. At presentation, the majority of patients have painless jaundice, pruritis, and malaise, a triad that develops secondary to obstruction, which often occurs late in the course of the disease process. The technical advancements in radiological imaging and endoscopic interventions have played a crucial role in the diagnosis, staging, and management of patients with pancreatic cancer. Endoscopic retrograde cholangiopancreatography (ERCP)-guided diagnosis (with brush cytology, serial pancreatic juice aspiration cytologic examination technique, or biliary biopsy) and therapeutic interventions such as pancreatobiliary decompression, intraductal and relief of gastric outlet obstruction play a pivotal role in the management of advanced pancreatic cancer and are increasingly used due to improved morbidity and complication rates compared to surgical management. In this review, we highlight various ERCP-guided diagnostic and therapeutic interventions for the management of pancreatic cancer.
Core Tip: Endoscopic retrograde cholangiopancreatography (ERCP)-guided interventions have an important role in the diagnosis, treatment, and palliation of pancreatic cancer. ERCP-guided biliary tissue sampling assists in diagnosing pancreatic cancer and permit therapeutic interventions during the same procedure (if needed). Advanced pancreatic cancers may result in biliary or gastric outlet obstruction. ERCP-guided deployment of either biliary or enteral stents provides effective palliation and improves the quality of life. The selection of biliary stent subtype depends on multiple factors including life expectancy, risk of complications, cost, and the need for ERCP-guided reinterventions. Self-expandable metal stents are preferred over plastic stents because of longer luminal patency, lower rates of stent dysfunction, and overall cost.