The Role of Interventional Endoscopy

  • Guido Costamagna
  • Pietro Familiari
  • Andrea Tringali
  • Ivo Boškoski
Part of the Medical Radiology book series (MEDRAD)


Interventional endoscopy has a key role in the palliation of pancreatic cancer.

Biliary obstruction leading to jaundice and hitching can be safely resolved by endoscopic plastic or metal stenting. Metal stents have a longer patency than plastic, and are cost-effective in patients with 4-6 months life expectancy. Endoscopic palliation of jaundice improves the quality of life, is mini-invasive, safe and effective and is preferred to surgery or interventional radiology. The main problem of biliary stents is cholangitis recurrence due to stent clogging: the development of new drug-eluting stent maybe will improve stent patency in the near future. Also pain in pancreatic cancer can be reduced by endoscopic pancreatic stenting or EUS-guided celiac plexus block/neurolysis in selected cases.

A late complication of pancreatic cancer is the developmant of a duodenal stricture and Gastric Outlet Obstruction Symptoms. This complication, which usually occurs in end-stage and fragile patients, can be resolved by endoscopic insertion of a duodenal metal stents. Duodenal stenting is preferred to surgery due to its lower morbidity and mortality, shorter hospitalization and earlier symptoms relief.

ERCP and EUS are also a tool for intraluminal brachytherapy and delivery of cytotoxic agents directly into the pancreatic tumor. This latest possibility can represent a future approach to pancreatic and other tumors.


Biliary Drainage Biliary Obstruction Plastic Stents Preoperative Biliary Drainage Celiac Plexus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abraham, N.S., Barkun, J.S., Barkun, A.N.: Palliation of malignant biliary obstruction: a prospective trial examining impact on quality of life. Gastrointest Endosc 56, 835–841 (2002)PubMedGoogle Scholar
  2. Adler, D.G., Baron, T.H.: Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97, 72–78 (2002)PubMedGoogle Scholar
  3. Andersen, J.R., Sorensen, S.M., Kruse, A., Rokkjaer, M., Matzen, P.: Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 30, 1132–1135 (1989)PubMedCentralPubMedGoogle Scholar
  4. Arhan, M., Odemis, B., Parlak, E., Ertugrul, I., Basar, O.: Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc 23, 769–775 (2009)PubMedGoogle Scholar
  5. Artifon, E.L., Sakai, P., Cunha, J.E., Dupont, A., Filho, F.M., Hondo, F.Y., Ishioka, S., Raju, G.S.: Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol 101, 2031–2037 (2006)PubMedGoogle Scholar
  6. Ballinger, A.B., McHugh, M., Catnach, S.M., Alstead, E.M., Clark, M.L.: Symptom relief and quality of life after stenting for malignant bile duct obstruction. Gut 35, 467–470 (1994)PubMedCentralPubMedGoogle Scholar
  7. Baron, T.H., Harewood, G.C.: Enteral self-expandable stents. Gastrointest Endosc 58, 421–433 (2003)PubMedGoogle Scholar
  8. Bessoud, B., de Baere, T., Denys, A., Kuoch, V., Ducreux, M., Precetti, S., Roche, A., Menu, Y.: Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol 16, 247–253 (2005)PubMedGoogle Scholar
  9. Bruha, R., Petrtyl, J., Kubecova, M., Marecek, Z., Dufek, V., Urbanek, P., Kodadova, J., Chodounsky, Z.: Intraluminal brachytherapy and selfexpandable stents in nonresectable biliary malignancies – the question of long-term palliation. Hepatogastroenterology 48, 631–637 (2001)PubMedGoogle Scholar
  10. Bueno, J.T., Gerdes, H., Kurtz, R.C.: Endoscopic management of occluded biliary Wallstents: A cancer center experience. Gastrointest Endosc 58, 879–884 (2003)PubMedGoogle Scholar
  11. Catalano, M.F., Geenen, J.E., Lehman, G.A., Siegel, J.H., Jacob, L., McKinley, M.J., Raijman, I., Meier, P., Jacobson, I., Kozarek, R., Al-Kawas, F.H., Lo, S.K., Dua, K.S., Baille, J., Ginsberg, G.G., Parsons, W., Meyerson, S.M., Cohen, S., Nelson, D.B., McHattie, J.D., Carr-Locke, D.L.: “Tannenbaum” Teflon stents versus traditional polyethylene stents for treatment of malignant biliary stricture. Gastrointest Endosc 55, 354–358 (2002)PubMedGoogle Scholar
  12. Cetta, F., Rappuoli, R., Montalto, G., Baldi, C., Gori, M., Cetta, D., Zuckermann, M., Magnani, A., Barbucci, R.: New biliary endoprosthesis less liable to block in biliary infections: description and in vitro studies. Eur J Surg 165, 782–785 (1999)PubMedGoogle Scholar
  13. Chang, K.J., Lee, J.G., Holcombe, R.F., Kuo, J., Muthusamy, R., Wu, M.L.: Endoscopic ultrasound delivery of an antitumor agent to treat a case of pancreatic cancer. Nat Clin Pract Gastroenterol Hepatol 5, 107–111 (2008)PubMedGoogle Scholar
  14. Chaurasia, O.P., Rauws, E.A., Fockens, P., Huibregtse, K.: Endoscopic techniques for retrieval of proximally migrated biliary stents: the Amsterdam experience. Gastrointest Endosc 50, 780–785 (1999)PubMedGoogle Scholar
  15. Chen, J.H., Sun, C.K., Liao, C.S., Chua, C.S.: Self-expandable metallic stents for malignant biliary obstruction: efficacy on proximal and distal tumors. World J Gastroenterol 12, 119–122 (2006)PubMedGoogle Scholar
  16. Christiaens, P., Decock, S., Buchel, O., Bulte, K., Moons, V., D’Haens, G., Van, O.G.: Endoscopic trimming of metallic stents with the use of argon plasma. Gastrointest Endosc 67, 369–371 (2008)PubMedGoogle Scholar
  17. Coates, J.M., Beal, S.H., Russo, J.E., Vanderveen, K.A., Chen, S.L., Bold, R.J., Canter, R.J.: Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy. Arch Surg 144, 841–847 (2009)PubMedGoogle Scholar
  18. Costamagna, G., Alevras, P., Palladino, F., Rainoldi, F., Mutignani, M., Morganti, A.: Endoscopic pancreatic stenting in pancreatic cancer. Can J Gastroenterol 13, 481–487 (1999)PubMedGoogle Scholar
  19. Costamagna, G., Mutignani, M., Rotondano, G., Cipolletta, L., Ghezzo, L., Foco, A., Zambelli, A.: Hydrophilic hydromer-coated polyurethane stents versus uncoated stents in malignant biliary obstruction: a randomized trial. Gastrointest Endosc 51, 8–11 (2000)PubMedGoogle Scholar
  20. Davids, P.H., Groen, A.K., Rauws, E.A., Tytgat, G.N., Huibregtse, K.: Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340, 1488–1492 (1992)PubMedGoogle Scholar
  21. Dormann, A., Meisner, S., Verin, N., Wenk, L.A.: Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 36, 543–550 (2004)PubMedGoogle Scholar
  22. Dowidar, N., Moesgaard, F., Matzen, P.: Clogging and other complications of endoscopic biliary endoprostheses. Scand J Gastroenterol 26, 1132–1136 (1991)PubMedGoogle Scholar
  23. Familiari, P., Bulajic, M., Mutignani, M., Lee, L.S., Spera, G., Spada, C., Tringali, A., Costamagna, G.: Endoscopic removal of malfunctioning biliary self-expandable metallic stents. Gastrointest Endosc 62, 903–910 (2005)PubMedGoogle Scholar
  24. Ferlitsch, A., Oesterreicher, C., Dumonceau, J.M., Deviere, J., Leban, T., Born, P., Rosch, T., Suter, W., Binek, J., Meyenberger, C., Mullner, M., Schneider, B., Schofl, R.: Diamond stents for palliation of malignant bile duct obstruction: A prospective multicenter evaluation. Endoscopy 33, 645–650 (2001)PubMedGoogle Scholar
  25. Freeman, M.L.: Adverse outcomes of ERCP. Gastrointest Endosc 56, S273–S282 (2002)PubMedGoogle Scholar
  26. Fritz, P., Brambs, H.J., Schraube, P., Freund, U., Berns, C., Wannenmacher, M.: Combined external beam radiotherapy and intraluminal high dose rate brachytherapy on bile duct carcinomas. Int J Radiat Oncol Biol Phys 29, 855–861 (1994)PubMedGoogle Scholar
  27. Fumex, F., Coumaros, D., Napoleon, B., Barthet, M., Laugier, R., Yzet, T., Le, S.A., Desurmont, P., Lamouliatte, H., Letard, J.C., Canard, J.M., Prat, F., Rey, J.F., Ponchon, T.: Similar performance but higher cholecystitis rate with covered biliary stents: results from a prospective multicenter evaluation. Endoscopy 38, 787–792 (2006)PubMedGoogle Scholar
  28. Gress, F., Schmitt, C., Sherman, S., Ciaccia, D., Ikenberry, S., Lehman, G.: Endoscopic ultrasound-guided celiac plexus block for managing abdominal pain associated with chronic pancreatitis: a prospective single center experience. Am J Gastroenterol 96, 409–416 (2001)PubMedGoogle Scholar
  29. Gunaratnam, N.T., Sarma, A.V., Norton, I.D., Wiersema, M.J.: A prospective study of EUS-guided celiac plexus neurolysis for pancreatic cancer pain. Gastrointest Endosc 54, 316–324 (2001)PubMedGoogle Scholar
  30. Herzog, T., Belyaev, O., Muller, C.A., Mittelkotter, U., Seelig, M.H., Weyhe, D., Felderbauer, P., Schlottmann, R., Schrader, H., Schmidt, W.E., Uhl, W.: Bacteribilia after preoperative bile duct stenting: a prospective study. J Clin Gastroenterol 43, 457–462 (2009)PubMedGoogle Scholar
  31. Ho, H., Mahajan, A., Gosain, S., Jain, A., Brock, A., Rehan, M.E., Ellen, K., Shami, V.M., Kahaleh, M.: Management of complications associated with partially covered biliary metal stents. Dig Dis Sci 55, 516–522 (2010)PubMedGoogle Scholar
  32. Holt, A.P., Patel, M., Ahmed, M.M.: Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice? Gastrointest Endosc 60, 1010–1017 (2004)PubMedGoogle Scholar
  33. Hosono, S., Ohtani, H., Arimoto, Y., Kanamiya, Y.: Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol 42, 283–290 (2007)PubMedGoogle Scholar
  34. Huibregtse, K.: Plastic or expandable biliary endoprostheses? Scand J Gastroenterol Suppl 200, 3–7 (1993)PubMedGoogle Scholar
  35. Ikeda, H., Kuroda, C., Uchida, H., Miyata, Y., Masaki, N., Shigematsu, Y., Monden, M., Okamura, J.: Intraluminal irradiation with iridium-192 wires for extrahepatic bile duct carcinoma–a preliminary report (author’s transl). Nippon Igaku Hoshasen Gakkai Zasshi 39, 1356–1358 (1979)PubMedGoogle Scholar
  36. Isayama, H., Komatsu, Y., Tsujino, T., Sasahira, N., Hirano, K., Toda, N., Nakai, Y., Yamamoto, N., Tada, M., Yoshida, H., Shiratori, Y., Kawabe, T., Omata, M.: A prospective randomised study of “covered” versus “uncovered” diamond stents for the management of distal malignant biliary obstruction. Gut 53, 729–734 (2004)PubMedCentralPubMedGoogle Scholar
  37. Isayama, H., Kawabe, T., Nakai, Y., Tsujino, T., Sasahira, N., Yamamoto, N., Arizumi, T., Togawa, O., Matsubara, S., Ito, Y., Sasaki, T., Hirano, K., Toda, N., Komatsu, Y., Tada, M., Yoshida, H., Omata, M.: Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 4, 1148–1153 (2006)PubMedGoogle Scholar
  38. Isayama, H., Nakai, Y., Toyokawa, Y., Togawa, O., Gon, C., Ito, Y., Yashima, Y., Yagioka, H., Kogure, H., Sasaki, T., Arizumi, T., Matsubara, S., Yamamoto, N., Sasahira, N., Hirano, K., Tsujino, T., Toda, N., Tada, M., Kawabe, T., Omata, M.: Measurement of radial and axial forces of biliary self-expandable metallic stents. Gastrointest Endosc 70, 37–44 (2009)PubMedGoogle Scholar
  39. Jeurnink, S.M., van Eijck, C.H., Steyerberg, E.W., Kuipers, E.J., Siersema, P.D.: Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol 7, 18 (2007a)PubMedCentralPubMedGoogle Scholar
  40. Jeurnink, S.M., Steyerberg, E.W., Hof, G., van Eijck, C.H., Kuipers, E.J., Siersema, P.D.: Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol 96, 389–396 (2007b)PubMedGoogle Scholar
  41. Johanson, J.F., Schmalz, M.J., Geenen, J.E.: Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 38, 341–346 (1992)PubMedGoogle Scholar
  42. Jung, G.S., Song, H.Y., Kang, S.G., Huh, J.D., Park, S.J., Koo, J.Y., Cho, Y.D.: Malignant gastroduodenal obstructions: Treatment by means of a covered expandable metallic stent-initial experience. Radiology 216, 758–763 (2000)PubMedGoogle Scholar
  43. Kaassis, M., Boyer, J., Dumas, R., Ponchon, T., Coumaros, D., Delcenserie, R., Canard, J.M., Fritsch, J., Rey, J.F., Burtin, P.: Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57, 178–182 (2003)PubMedGoogle Scholar
  44. Kahaleh, M., Tokar, J., Conaway, M.R., Brock, A., Le, T., Adams, R.B., Yeaton, P.: Efficacy and complications of covered Wallstents in malignant distal biliary obstruction. Gastrointest Endosc 61, 528–533 (2005)PubMedGoogle Scholar
  45. Katsinelos, P., Kountouras, J., Paroutoglou, G., Paikos, D., Moschos, J., Chatzimavroudis, G., Zavos, C., Makrigiannis, E.: Uncovered Hanaro versus Luminex metal stents for palliation of malignant biliary strictures. J Clin Gastroenterol 42, 539–545 (2008)PubMedGoogle Scholar
  46. Kaufman, M., Singh, G., Das, S., Concha-Parra, R., Erber, J., Micames, C., Gress, F.: Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer. J Clin Gastroenterol 44, 127–134 (2010)PubMedGoogle Scholar
  47. Kaw, M., Singh, S., Gagneja, H.: Clinical outcome of simultaneous self-expandable metal stents for palliation of malignant biliary and duodenal obstruction. Surg Endosc 17, 457–461 (2003)PubMedGoogle Scholar
  48. Kim, H.S., Lee, D.K., Kim, H.G., Park, J.J., Park, S.H., Kim, J.H., Yoo, B.M., Roe, I.H., Moon, Y.S., Myung, S.J.: Features of malignant biliary obstruction affecting the patency of metallic stents: a multicenter study. Gastrointest Endosc 55, 359–365 (2002)PubMedGoogle Scholar
  49. Kim, J.H., Song, H.Y., Shin, J.H., Choi, E., Kim, T.W., Jung, H.Y., Lee, G.H., Lee, S.K., Kim, M.H., Ryu, M.H., Kang, Y.K., Kim, B.S., Yook, J.H.: Metallic stent placement in the palliative treatment of malignant gastroduodenal obstructions: prospective evaluation of results and factors influencing outcome in 213 patients. Gastrointest Endosc 66, 256–264 (2007)PubMedGoogle Scholar
  50. Kocak, Z., Ozkan, H., Adli, M., Garipagaoglu, M., Kurtman, C., Cakmak, A.: Intraluminal brachytherapy with metallic stenting in the palliative treatment of malignant obstruction of the bile duct. Radiat Med 23, 200–207 (2005)PubMedGoogle Scholar
  51. Laasch, H.U., Martin, D.F., Maetani, I.: Enteral stents in the gastric outlet and duodenum. Endoscopy 37, 74–81 (2005)PubMedGoogle Scholar
  52. Landoni, N., Wengrower, D., Chopita, N., Goldin, E.: Randomized prospective study to compare the efficiency between standard plastic and polyurethane stents in biliary tract malignant obstruction. Acta Gastroenterol Latinoam 30, 501–504 (2000)PubMedGoogle Scholar
  53. Lee, D.K., Kim, H.S., Kim, K.S., Lee, W.J., Kim, H.K., Won, Y.H., Byun, Y.R., Kim, M.Y., Baik, S.K., Kwon, S.O.: The effect on porcine bile duct of a metallic stent covered with a paclitaxel-incorporated membrane. Gastrointest Endosc 61, 296–301 (2005)PubMedGoogle Scholar
  54. Lee, S.M., Kang, D.H., Kim, G.H., Park, W.I., Kim, H.W., Park, J.H.: Self-expanding metallic stents for gastric outlet obstruction resulting from stomach cancer: a preliminary study with a newly designed double-layered pyloric stent. Gastrointest Endosc 66, 1206–1210 (2007)PubMedGoogle Scholar
  55. Lermite, E., Pessaux, P., Teyssedou, C., Etienne, S., Brehant, O., Arnaud, J.P.: Effect of preoperative endoscopic biliary drainage on infectious morbidity after pancreatoduodenectomy: a case-control study. Am J Surg 195, 442–446 (2008)PubMedGoogle Scholar
  56. Leung, J., Rahim, N.: The role of covered self-expandable metallic stents in malignant biliary strictures. Gastrointest Endosc 63, 1001–1003 (2006)PubMedGoogle Scholar
  57. Leung, J.W., Lau, G.T., Sung, J.J., Costerton, J.W.: Decreased bacterial adherence to silver-coated stent material: an in vitro study. Gastrointest Endosc 38, 338–340 (1992)PubMedGoogle Scholar
  58. Levy, M., Rajan, E., Keeney, G., Fletcher, J.G., Topazian, M.: Neural ganglia visualized by endoscopic ultrasound. Am J Gastroenterol 101, 1787–1791 (2006)PubMedGoogle Scholar
  59. Lillemoe, K.D., Pitt, H.A.: Palliation. Surgical and otherwise. Cancer 78, 605–614 (1996)PubMedGoogle Scholar
  60. Lo, C.H., Chung, S., Bohmer, R.D.: A devastating complication: duodenal perforation due to biliary stent migration. Surg Laparosc Endosc Percutan Tech 18, 608–610 (2008)PubMedGoogle Scholar
  61. Lowe, A.S., Beckett, C.G., Jowett, S., May, J., Stephenson, S., Scally, A., Tam, E., Kay, C.L.: Self-expandable metal stent placement for the palliation of malignant gastroduodenal obstruction: experience in a large, single, UK centre. Clin Radiol 62, 738–744 (2007)PubMedGoogle Scholar
  62. Luman, W., Cull, A., Palmer, K.R.: Quality of life in patients stented for malignant biliary obstructions. Eur J Gastroenterol Hepatol 9, 481–484 (1997)PubMedGoogle Scholar
  63. Machan, L.: Clinical experience and applications of drug-eluting stents in the noncoronary vasculature, bile duct and esophagus. Adv Drug Deliv Rev 58, 447–462 (2006)PubMedGoogle Scholar
  64. Maetani, I., Ukita, T., Inone, H., Yoshida, M., Igarashi, Y., Sakai, Y.: Knitted nitinol stent insertion for various intestinal stenoses with a modified delivery system. Gastrointest Endosc 54, 364–367 (2001)PubMedGoogle Scholar
  65. Maetani, I., Tada, T., Shimura, J., Ukita, T., Inoue, H., Igarashi, Y., Hoshi, H., Sakai, Y.: Technical modifications and strategies for stenting gastric outlet strictures using esophageal endoprostheses. Endoscopy 34, 402–406 (2002)PubMedGoogle Scholar
  66. Maetani, I., Tada, T., Ukita, T., Inoue, H., Sakai, Y., Nagao, J.: Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy 36, 73–78 (2004)PubMedGoogle Scholar
  67. Maetani, I., Akatsuka, S., Ikeda, M., Tada, T., Ukita, T., Nakamura, Y., Nagao, J., Sakai, Y.: Self-expandable metallic stent placement for palliation in gastric outlet obstructions caused by gastric cancer: a comparison with surgical gastrojejunostomy. J Gastroenterol 40, 932–937 (2005)PubMedGoogle Scholar
  68. Maetani, I., Isayama, H., Mizumoto, Y.: Palliation in patients with malignant gastric outlet obstruction with a newly designed enteral stent: A multicenter study. Gastrointest Endosc 66, 355–360 (2007)PubMedGoogle Scholar
  69. Matsuda, Y., Shimakura, K., Akamatsu, T.: Factors affecting the patency of stents in malignant biliary obstructive disease: univariate and multivariate analysis. Am J Gastroenterol 86, 843–849 (1991)PubMedGoogle Scholar
  70. Menon, K., Barkun, A.: Management of occluded biliary Wallstents. Gastrointest Endosc 49, 403–405 (1999)PubMedGoogle Scholar
  71. Mezhir, J.J., Brennan, M.F., Baser, R.E., D’Angelica, M.I., Fong, Y., Dematteo, R.P., Jarnagin, W.R., Allen, P.J.: A matched case-control study of preoperative biliary drainage in patients with pancreatic adenocarcinoma: Routine drainage is not justified. J Gastrointest Surg 13(12), 2163–2169 (2009)PubMedGoogle Scholar
  72. Mishra, G., Liu, T.F., Frankel, A.E.: Recombinant toxin DAB389EGF is cytotoxic to human pancreatic cancer cells. Expert Opin Biol Ther 3, 1173–1180 (2003)PubMedGoogle Scholar
  73. Mittal, A., Windsor, J., Woodfield, J., Casey, P., Lane, M.: Matched study of three methods for palliation of malignant pyloroduodenal obstruction. Br J Surg 91, 205–209 (2004)PubMedGoogle Scholar
  74. Moss, A.C., Morris, E., Mac, M.P.: Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev 2006;CD004200.Google Scholar
  75. Moss, A.C., Morris, E., Leyden, J., MacMathuna, P.: Do the benefits of metal stents justify the costs? A systematic review and meta-analysis of trials comparing endoscopic stents for malignant biliary obstruction. Eur J Gastroenterol Hepatol 19, 1119–1124 (2007)PubMedGoogle Scholar
  76. Mutignani, M., Shah, S.K., Morganti, A.G., Perri, V., Macchia, G., Costamagna, G.: Treatment of unresectable pancreatic carcinoma by intraluminal brachytherapy in the duct of Wirsung. Endoscopy 34, 555–559 (2002)PubMedGoogle Scholar
  77. Mutignani, M., Tringali, A., Shah, S.G., Perri, V., Familiari, P., Iacopini, F., Spada, C., Costamagna, G.: Combined endoscopic stent insertion in malignant biliary and duodenal obstruction. Endoscopy 39, 440–447 (2007)PubMedGoogle Scholar
  78. Mutignani, M., Iacopini, F., Perri, V., Familiari, P., Tringali, A., Spada, C., Ingrosso, M., Costamagna, G.: Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy 41, 539–546 (2009)PubMedGoogle Scholar
  79. Nakai, Y., Isayama, H., Komatsu, Y., Tsujino, T., Toda, N., Sasahira, N., Yamamoto, N., Hirano, K., Tada, M., Yoshida, H., Kawabe, T., Omata, M.: Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction. Gastrointest Endosc 62, 742–748 (2005)PubMedGoogle Scholar
  80. Ornellas, L.C., Stefanidis, G., Chuttani, R., Gelrud, A., Kelleher, T.B., Pleskow, D.K.: Covered Wallstents for palliation of malignant biliary obstruction: Primary stent placement versus reintervention. Gastrointest Endosc 70, 676–683 (2009)PubMedGoogle Scholar
  81. Park, D.H., Kim, M.H., Choi, J.S., Lee, S.S., Seo, D.W., Kim, J.H., Han, J., Kim, J.C., Choi, E.K., Lee, S.K.: Covered versus uncovered wallstent for malignant extrahepatic biliary obstruction: a cohort comparative analysis. Clin Gastroenterol Hepatol 4, 790–796 (2006)Google Scholar
  82. Pausawasdi, N., Scheiman, J.: Endoscopic evaluation and palliation of pancreatic adenocarcinoma: current and future options. Curr Opin Gastroenterol 23, 515–521 (2007)PubMedGoogle Scholar
  83. Pedersen, F.M.: Endoscopic management of malignant biliary obstruction. Is stent size of 10 French gauge better than 7 French gauge? Scand J Gastroenterol 28, 185–189 (1993)PubMedGoogle Scholar
  84. Perdue, D.G., Freeman, M.L., DiSario, J.A., Nelson, D.B., Fennerty, M.B., Lee, J.G., Overby, C.S., Ryan, M.E., Bochna, G.S., Snady, H.W., Moore, J.P.: Plastic versus self-expanding metallic stents for malignant hilar biliary obstruction: A prospective multicenter observational cohort study. J Clin Gastroenterol 42, 1040–1046 (2008)PubMedGoogle Scholar
  85. Piesman, M., Kozarek, R.A., Brandabur, J.J., Pleskow, D.K., Chuttani, R., Eysselein, V.E., Silverman, W.B., Vargo, J.J., Waxman, I., Catalano, M.F., Baron, T.H., Parsons III, W.G., Slivka, A., Carr-Locke, D.L.: Improved oral intake after palliative duodenal stenting for malignant obstruction: a prospective multicenter clinical trial. Am J Gastroenterol 104, 2404–2411 (2009)PubMedGoogle Scholar
  86. Raijman, I.: Biliary and pancreatic stents. Gastrointest Endosc Clin North Am 13, 561–592 (2003)Google Scholar
  87. Rogart, J.N., Boghos, A., Rossi, F., Al-Hashem, H., Siddiqui, U.D., Jamidar, P., Aslanian, H.: Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center. Gastrointest Endosc 68, 676–682 (2008)PubMedGoogle Scholar
  88. Sarr, M.G., Cameron, J.L.: Surgical management of unresectable carcinoma of the pancreas. Surgery 91, 123–133 (1982)PubMedGoogle Scholar
  89. Schiefke, I., Zabel-Langhennig, A., Wiedmann, M., Huster, D., Witzigmann, H., Mossner, J., Berr, F., Caca, K.: Self-expandable metallic stents for malignant duodenal obstruction caused by biliary tract cancer. Gastrointest Endosc 58, 213–219 (2003)PubMedGoogle Scholar
  90. Schilling, D., Rink, G., Arnold, J.C., Benz, C., Adamek, H.E., Jakobs, R., Riemann, J.F.: Prospective, randomized, single-center trial comparing 3 different 10F plastic stents in malignant mid and distal bile duct strictures. Gastrointest Endosc 58, 54–58 (2003)PubMedGoogle Scholar
  91. Schmassmann, A., von Gunten, E., Knuchel, J., Scheurer, U., Fehr, H.F., Halter, F.: Wallstents versus plastic stents in malignant biliary obstruction: effects of stent patency of the first and second stent on patient compliance and survival. Am J Gastroenterol 91, 654–659 (1996)PubMedGoogle Scholar
  92. Shah, R.J., Howell, D.A., Desilets, D.J., Sheth, S.G., Parsons, W.G., Okolo III, P., Lehman, G.A., Sherman, S., Baillie, J., Branch, M.S., Pleskow, D., Chuttani, R., Bosco, J.J.: Multicenter randomized trial of the spiral Z-stent compared with the Wallstent for malignant biliary obstruction. Gastrointest Endosc 57, 830–836 (2003)PubMedGoogle Scholar
  93. Shepherd, H.A., Royle, G., Ross, A.P., Diba, A., Arthur, M., Colin-Jones, D.: Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg 75, 1166–1168 (1988)PubMedGoogle Scholar
  94. Shin, H.S., Seong, J., Kim, W.C., Lee, H.S., Moon, S.R., Lee, I.J., Lee, K.K., Park, K.R., Suh, C.O., Kim, G.E.: Combination of external beam irradiation and high-dose-rate intraluminal brachytherapy for inoperable carcinoma of the extrahepatic bile ducts. Int J Radiat Oncol Biol Phys 57, 105–112 (2003)PubMedGoogle Scholar
  95. Siddiqui, A., Spechler, S.J., Huerta, S.: Surgical bypass versus endoscopic stenting for malignant gastroduodenal obstruction: a decision analysis. Dig Dis Sci 52, 276–281 (2007)PubMedGoogle Scholar
  96. Simmons, D.T., Petersen, B.T., Gostout, C.J., Levy, M.J., Topazian, M.D., Baron, T.H.: Risk of pancreatitis following endoscopically placed large-bore plastic biliary stents with and without biliary sphincterotomy for management of postoperative bile leaks. Surg Endosc 22, 1459–1463 (2008)PubMedGoogle Scholar
  97. Smith, A.C., Dowsett, J.F., Russell, R.C., Hatfield, A.R., Cotton, P.B.: Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet 344, 1655–1660 (1994)PubMedGoogle Scholar
  98. Soderlund, C., Linder, S.: Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc 63, 986–995 (2006)PubMedGoogle Scholar
  99. Soehendra, N., Maydeo, A., Eckmann, B., Bruckner, M., Nam, V.C., Grimm, H.: A new technique for replacing an obstructed biliary endoprosthesis. Endoscopy 22, 271–272 (1990)PubMedGoogle Scholar
  100. Song, H.Y., Yang, D.H., Kuh, J.H., Choi, K.C.: Obstructing cancer of the gastric antrum: Palliative treatment with covered metallic stents. Radiology 187, 357–358 (1993)PubMedGoogle Scholar
  101. Speer, A.G., Cotton, P.B., Russell, R.C., Mason, R.R., Hatfield, A.R., Leung, J.W., MacRae, K.D., Houghton, J., Lennon, C.A.: Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 2, 57–62 (1987)PubMedGoogle Scholar
  102. Stawowy, M., Kruse, A., Mortensen, F.V., Funch-Jensen, P.: Endoscopic stenting for malignant gastric outlet obstruction. Surg Laparosc Endosc Percutan Tech 17, 5–9 (2007)PubMedGoogle Scholar
  103. Stoeckel, D., Pelton, A., Duerig, T.: Self-expanding nitinol stents: material and design considerations. Eur Radiol 14, 292–301 (2004)PubMedGoogle Scholar
  104. Storkson, R.H., Edwin, B., Reiertsen, O., Faerden, A.E., Sortland, O., Rosseland, A.R.: Gut perforation caused by biliary endoprosthesis. Endoscopy 32, 87–89 (2000)PubMedGoogle Scholar
  105. Suk, K.T., Kim, J.W., Kim, H.S., Baik, S.K., Oh, S.J., Lee, S.J., Kim, H.G., Lee, D.H., Won, Y.H., Lee, D.K.: Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study. Gastrointest Endosc 66, 798–803 (2007)PubMedGoogle Scholar
  106. Sunpaweravong, S., Ovartlarnporn, B., Khow-ean, U., Soontrapornchai, P., Charoonratana, V.: Endoscopic stenting versus surgical bypass in advanced malignant distal bile duct obstruction: cost-effectiveness analysis. Asian J Surg 28, 262–265 (2005)PubMedGoogle Scholar
  107. Telford, J.J., Carr-Locke, D.L., Baron, T.H., Tringali, A., Parsons, W.G., Gabbrielli, A., Costamagna, G.: Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study. Gastrointest Endosc 60, 916–920 (2004)PubMedGoogle Scholar
  108. Tham, T.C., Carr-Locke, D.L., Vandervoort, J., Wong, R.C., Lichtenstein, D.R., Van, D.J., Ruymann, F., Chow, S., Bosco, J.J., Qaseem, T., Howell, D., Pleskow, D., Vannerman, W., Libby, E.D.: Management of occluded biliary Wallstents. Gut 42, 703–707 (1998)PubMedCentralPubMedGoogle Scholar
  109. Tham, T.C., Lichtenstein, D.R., Vandervoort, J., Wong, R.C., Slivka, A., Banks, P.A., Yim, H.B., Carr-Locke, D.L.: Pancreatic duct stents for “obstructive type” pain in pancreatic malignancy. Am J Gastroenterol 95, 956–960 (2000)PubMedGoogle Scholar
  110. Topazian, M., Baron, T.H.: Endoscopic fenestration of duodenal stents using argon plasma to facilitate ERCP. Gastrointest Endosc 69, 166–169 (2009)PubMedGoogle Scholar
  111. Tringali, A., Mutignani, M., Perri, V., Zuccala, G., Cipolletta, L., Bianco, M.A., Rotondano, G., Philipper, M., Schumacher, B., Neuhaus, H., Schmit, A., Deviere, J., Costamagna, G.: A prospective, randomized multicenter trial comparing double layer and polyethylene stents for malignant distal common bile duct strictures. Endoscopy 35, 992–997 (2003)PubMedGoogle Scholar
  112. Truong, S., Bohndorf, V., Geller, H., Schumpelick, V., Gunther, R.W.: Self-expanding metal stents for palliation of malignant gastric outlet obstruction. Endoscopy 24, 433–435 (1992)PubMedGoogle Scholar
  113. van Berkel, A.M., Boland, C., Redekop, W.K., Bergman, J.J., Groen, A.K., Tytgat, G.N., Huibregtse, K.: A prospective randomized trial of Teflon versus polyethylene stents for distal malignant biliary obstruction. Endoscopy 30, 681–686 (1998)PubMedGoogle Scholar
  114. van Berkel, A.M., van Marle, J., Groen, A.K., Bruno, M.J.: Mechanisms of biliary stent clogging: confocal laser scanning and scanning electron microscopy. Endoscopy 37, 729–734 (2005)PubMedGoogle Scholar
  115. van Hooft, J., Mutignani, M., Repici, A., Messmann, H., Neuhaus, H., Fockens, P.: First data on the palliative treatment of patients with malignant gastric outlet obstruction using the WallFlex enteral stent: a retrospective multicenter study. Endoscopy 39, 434–439 (2007)PubMedGoogle Scholar
  116. van Steenbergen, W., van Aken, L., Ponette, E.: Acute pancreatitis complicating the insertion of a self-expandable biliary metal stent. Endoscopy 24, 440–442 (1992)PubMedGoogle Scholar
  117. Wang, Q., Gurusamy, K.S., Lin, H., Xie, X., Wang, C.: Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst Rev 2008;CD005444.Google Scholar
  118. Warshaw, A.L., Fernandez-del, C.C.: Pancreatic carcinoma. N Engl J Med 326, 455–465 (1992)PubMedGoogle Scholar
  119. Watanapa, P., Williamson, R.C.: Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 79, 8–20 (1992)PubMedGoogle Scholar
  120. Weber, A., Mittermeyer, T., Wagenpfeil, S., Schmid, R.M., Prinz, C.: Self-expanding metal stents versus polyethylene stents for palliative treatment in patients with advanced pancreatic cancer. Pancreas 38, e7–e12 (2009)PubMedGoogle Scholar
  121. Weickert, U., Zimmerling, S., Eickhoff, A., Riemann, J.F., Reiss, G.: A comparative scanning electron microscopic study of biliary and pancreatic stents. Z Gastroenterol 47, 347–350 (2009)PubMedGoogle Scholar
  122. Wiersema, M.J., Wiersema, L.M.: Endosonography-guided celiac plexus neurolysis. Gastrointest Endosc 44, 656–662 (1996)PubMedGoogle Scholar
  123. Wong, Y.T., Brams, D.M., Munson, L., Sanders, L., Heiss, F., Chase, M., Birkett, D.H.: Gastric outlet obstruction secondary to pancreatic cancer: Surgical vs endoscopic palliation. Surg Endosc 16, 310–312 (2002)PubMedGoogle Scholar
  124. Yan, B.M., Myers, R.P.: Neurolytic celiac plexus block for pain control in unresectable pancreatic cancer. Am J Gastroenterol 102, 430–438 (2007)PubMedGoogle Scholar
  125. Yang, K.Y., Ryu, J.K., Seo, J.K., Woo, S.M., Park, J.K., Kim, Y.T., Yoon, Y.B.: A comparison of the Niti-D biliary uncovered stent and the uncovered Wallstent in malignant biliary obstruction. Gastrointest Endosc 70, 45–51 (2009)PubMedGoogle Scholar
  126. Yeoh, K.G., Zimmerman, M.J., Cunningham, J.T., Cotton, P.B.: Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 49, 466–471 (1999)PubMedGoogle Scholar
  127. Yim, H.B., Jacobson, B.C., Saltzman, J.R., Johannes, R.S., Bounds, B.C., Lee, J.H., Shields, S.J., Ruymann, F.W., Van, D.J., Carr-Locke, D.L.: Clinical outcome of the use of enteral stents for palliation of patients with malignant upper GI obstruction. Gastrointest Endosc 53, 329–332 (2001)PubMedGoogle Scholar
  128. Yoon, W.J., Lee, J.K., Lee, K.H., Lee, W.J., Ryu, J.K., Kim, Y.T., Yoon, Y.B.: A comparison of covered and uncovered Wallstents for the management of distal malignant biliary obstruction. Gastrointest Endosc 63, 996–1000 (2006)PubMedGoogle Scholar
  129. Yoon, W.J., Ryu, J.K., Yang, K.Y., Paik, W.H., Lee, J.K., Woo, S.M., Park, J.K., Kim, Y.T., Yoon, Y.B.: A comparison of metal and plastic stents for the relief of jaundice in unresectable malignant biliary obstruction in Korea: an emphasis on cost-effectiveness in a country with a low ERCP cost. Gastrointest Endosc 70, 284–289 (2009)PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Guido Costamagna
    • 1
  • Pietro Familiari
    • 1
  • Andrea Tringali
    • 1
  • Ivo Boškoski
    • 1
  1. 1.Digestive Endoscopy UnitGemelli University Hospital, Università Cattolica del Sacro CuoreRomeItaly

Personalised recommendations