title: Managing malignant biliary obstruction in pancreas cancer: choosing the appropriate strategy.
abstract: 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.
authors: Brian R Boulay, Mayur Parepally, Division of Gastroenterology and Hepatology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, United States.
authors: Brian R
authors: BR
authors: Boulay
authors: Brian R Boulay, Mayur Parepally, Division of Gastroenterology and Hepatology, University of Illinois Hospital and Health Sciences System, Chicago, IL 60612, United States.
authors: Mayur
authors: M
authors: Parepally
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation; D002779:Cholestasis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D019299:Decompression, Surgical; D004322:Drainage / Q000295:instrumentation / Q000379:methods*; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008670:Metals; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D010969:Plastics; D011474:Prosthesis Design; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010969:Plastics
keywords: Biliary tract diseases; Cholestasis; Extrahepatic; Pancreatic neoplasms; Stents