Published online Jul 28, 2014. doi: 10.3748/wjg.v20.i28.9345
Revised: January 30, 2014
Accepted: March 12, 2014
Published online: July 28, 2014
Most patients with pancreatic cancer develop malignant biliary obstruction. Treatment of obstruction is generally indicated to relieve symptoms and improve morbidity and mortality. First-line therapy consists of endoscopic biliary stent placement. Recent data comparing plastic stents to self-expanding metallic stents (SEMS) has shown improved patency with SEMS. The decision of whether to treat obstruction and the means for doing so depends on the clinical scenario. For patients with resectable disease, preoperative biliary decompression is only indicated when surgery will be delayed or complications of jaundice exist. For patients with locally advanced disease, self-expanding metal stents are superior to plastic stents for long-term patency. For patients with advanced disease, the choice of metallic or plastic stent depends on life expectancy. When endoscopic stent placement fails, percutaneous or surgical treatments are appropriate. Endoscopic therapy or surgical approach can be used to treat concomitant duodenal and biliary obstruction.
Core tip: Biliary obstruction is a common problem in pancreatic malignancy. Relief of obstruction is commonly performed using endoscopic stent placement. Clinical setting determines the strategy, including whether decompression is needed and which stent type is most appropriate. Self-expanding metallic stents have longer patency than plastic stents and are preferred in most settings. When endoscopic therapy fails, percutaneous or surgical strategies may be used.