Skip to main content

Advertisement

SpringerLink
Log in

A multimodal, one-session endoscopic approach for management of patients with advanced pancreatic cancer

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

A number of patients with inoperable pancreatic cancer may concurrently complain of pain, biliary obstruction, and duodenal stenosis. Endoscopic palliative treatments and opioid therapy are generally performed in these patients. The study aimed to assess the efficacy and safety of a multimodal ‘one-Session Three Endoscopic Procedures’ (one-STEP) to simultaneously treat cholestasis, restore duodenal transit, and achieve pain relief in selected patients with advanced pancreatic cancer.

Methods

Selected patients diagnosed with an advanced pancreatic cancer presenting with biliary obstruction, duodenal stenosis, and severe pain treated with the one-STEP were considered. The one-STEP endoscopic approach included biliary and duodenal stenting, and EUS-guided celiac plexus neurolysis. The technical success rate, complications, pain relief, and opioid use at follow-up were assessed.

Results

A total of 15 patients were treated. The one-STEP was successful in 13 (87 %) cases, while it failed in two patients due to the impossibility of dilating the neoplastic mass for creating a fistula. No endoscopy-related complications occurred. The median of pain intensity was 8 (range 7–10) at entry and significantly decreased to 2 (range 2–4) 72 h following celiac plexus neurolysis. At follow-up (median survival 4 months; range 3–8), only 3 (20 %) needed of narcotic treatment in the last period.

Conclusions

The multimodal one-STEP is an effective and safe endoscopic approach for palliative treatment of biliary and duodenal stenosis, and for relieving chronic pain in patients with advanced pancreatic cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, Thun MJ (2008) Cancer statistics, 2008. CA Cancer J Clin 58:71–96

    Article  PubMed  Google Scholar 

  2. Bilimoria KY, Bentrem DJ, Ko CY, Ritchey J, Stewart AK, Winchester DP, Talamonti MS (2007) Validation of the 6th edition AJCC Pancreatic Cancer Staging System: report from the National Cancer Database. Cancer 110:738–744

    Article  PubMed  Google Scholar 

  3. Jooste V, Grosclaude P, Remontet L, Launoy G, Baldi I, Molinié F, Arveux P, Bossard N, Bouvier AM, Colonna M (2013) Unbiased estimates of long-term net survival of solid cancers in France. Int J Cancer 132:2370–2377

    Article  CAS  PubMed  Google Scholar 

  4. Seicean A (2014) Celiac plexus neurolysis in pancreatic cancer: the endoscopic ultrasound approach. World J Gastroenterol 20:110–117

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cherny Nathan I (2005) Opioids in the management of cancer pain. Eur J Cancer 3:61–75

    Article  CAS  Google Scholar 

  6. Teshima CW, Sandha GS (2014) Endoscopic ultrasound in the diagnosis and treatment of pancreatic disease. World J Gastroenterol 20:9976–9989

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ghaneh P, Costello E, Neoptolemos JP (2007) Biology and management of pancreatic cancer. Gut 56:1134–1152

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Giovannini M, Bories E, Téllez-Ávila FI (2012) Endoscopic ultrasound-guided bilio-pancreatic drainage. Endosc. Ultrasound 1:119–129

    Google Scholar 

  9. Mutignani M, Trincali A, Shah SG, Perri V, Familiari P, Iacopini F, Spada C, Costamagna G (2007) Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy 39:440–447

    Article  CAS  PubMed  Google Scholar 

  10. Wyse JM, Carone M, Paquin SC, Usatii M, Sahai AV (2011) Randomized, double-blind, controlled trial of early endoscopic ultrasound–guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer. J Clin Oncol 29:3541–3546

    Article  PubMed  Google Scholar 

  11. Shah A, Fehmi A, Savides TJ (2014) Increased rates of duodenal obstruction in pancreatic cancer patients receiving modern medical management. Dig Dis Sci 59:2294–2298

    Article  PubMed  Google Scholar 

  12. Boulay BR, Parepally M (2014) Managing malignant biliary obstruction in pancreas cancer: choosing the appropriate strategy. World J Gastroenterol 20:9345–9353

    PubMed  PubMed Central  Google Scholar 

  13. Yu J, Hao J, Wu D, Lang H (2014) Retrospective evaluation of endoscopic stenting of combined malignant common bile duct and gastric outlet-duodenum obstructions. Exp Ther Med 8:1173–1177

    PubMed  PubMed Central  Google Scholar 

  14. Canena J, Coimbra J, Carvalho D, Rodrigues C, Silva M, Costa M, Horta D, Mateus Dias A, Seves I, Ramos G, Ricardo L, Coutinho AP, Romão C, Veiga PM (2014) Endoscopic bilio-duodenal bypass: outcomes of primary and revision efficacy of combined metallic stents in malignant duodenal and biliary obstructions. Dig Dis Sci 59:2779–2789

    Article  CAS  PubMed  Google Scholar 

  15. Hamada T, Isayama H, Nakai Y, Kogure H, Yamamoto N, Kawakubo K, Takahara N, Uchino R, Mizuno S, Sasaki T, Togawa O, Matsubara S, Ito Y, Hirano K, Tsujino T, Tada M, Koike K (2014) Transmural biliary drainage can be an alternative to transpapillary drainage in patients with an indwelling duodenal stent. Dig Dis Sci 59:1931–1938

    Article  CAS  PubMed  Google Scholar 

  16. Sasaki T, Isayama H, Nakai Y, akahara N, Hamada T, Mizuno S, Mohri D, Yagioka H, Kogure H, Arizumi T, Togawa O, Matsubara S, Ito Y, Yamamoto N, Sasahira N, Hirano K, Toda N, Tada M, Koike K (2014) Clinical outcomes of secondary gastroduodenal self-expandable metallic stent placement by stent-in-stent technique for malignant gastric outlet obstruction. Dig Endosc 4 [Epub ahead of print]

  17. Di Matteo F, Shimpi L, Gabbrielli A, Martino M, Caricato M, Esposito A, De Cicco ML, Coppola R, Costamagna G (2006) Same-day endoscopic retrograde cholangiopancreatography after transduodenal endoscopic ultrasound-guided needle aspiration: do we need to be cautious? Endoscopy 38:1149–1151

    Article  PubMed  Google Scholar 

  18. Puli SR, Reddy JB, Bechtold ML, Antillon MR, Brugge WR (2009) EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci 54:2330–2337

    Article  PubMed  Google Scholar 

  19. Fabbri C, Luigiano C, Risotti A, Cennamo V, Virgilio C, Caletti G, Fusaroli P (2014) Endoscopic ultrasound-guided treatments: are we getting evidence based-a systematic review. World J Gastroenterol 20:8424–8448

    Article  PubMed  PubMed Central  Google Scholar 

  20. Ishiwatari H, Hayashi T, Yoshida M, Ono M, Masuko H, Sato T, Miyanishi K, Sato Y, Takimoto R, Kobune M, Miyamoto A, Sonoda T, Kato J (2014) Phenol-based endoscopic ultrasound-guided celiac plexus neurolysis for East Asian alcohol-intolerant upper gastrointestinal cancer patients: a pilot study. World J Gastroenterol 20:10512–10517

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Interventional Digestive Endoscopy, “Niguarda Ca’ Granda” Hospital, Milan, Italy

    Raffaele Manta & Massimiliano Mutignani

  2. Gastroenterology and Digestive Endoscopy Unit, “Nuovo Civile Sant’Agostino – Estense” Hospital, Baggiovara, Modena, Italy

    Raffaele Manta, Rita Conigliaro, Santi Mangiafico, Edoardo Forti, Helga Bertani & Marzio Frazzoni

  3. Department of Clinical Medicine and Surgery, Surgical Digestive Endoscopy Unit, Federico II University, Naples, Italy

    Giuseppe Galloro

  4. Gastroenterology and Digestive Endoscopy, “Nuovo Regina Margherita” Hospital, Rome, Italy

    Angelo Zullo

Authors
  1. Raffaele Manta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rita Conigliaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Santi Mangiafico
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Edoardo Forti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helga Bertani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marzio Frazzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giuseppe Galloro
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Massimiliano Mutignani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Angelo Zullo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Angelo Zullo.

Ethics declarations

Disclosure

Raffaele Manta, Rita Conigliaro, Santi Mangiafico, Helga Bertani, Edoardo Forti, Massimilano Mutignani, Marzio Frazzoni, Giuseppe Galloro, and Angelo Zullo have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Manta, R., Conigliaro, R., Mangiafico, S. et al. A multimodal, one-session endoscopic approach for management of patients with advanced pancreatic cancer. Surg Endosc 30, 1863–1868 (2016). https://doi.org/10.1007/s00464-015-4403-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4403-7

Keywords

Search

Navigation