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Treatment of Pancreatic Cancer

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Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy

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Abstract

Pancreatic carcinoma is considered as one of the most aggressive tumors among GI malignancies. Globally, the number of deaths, incident cases, and disease-adjusted life years caused by pancreatic cancer have more than doubled from 1990 to the present. Since symptoms often do not occur until advanced disease is present, the majority of these pancreatic carcinomas is unresectable at the time of presentation. Whereas surgical treatment remains the only curative therapy, endoscopy is an important treatment option for unresectable pancreatic cancer. Therefore, palliation of symptoms including pain, jaundice, and pruritus is the main objective in these patients. Endoscopic palliation is minimally invasive and consequently associated with decreased morbidity compared to palliative surgery. Endoscopic treatment options include elimination of biliary obstruction by ERCP or EUS (either preoperatively to treat cholangitis or as definite solution in terms of a palliative therapeutic approach), therapy of gastric outlet obstruction, tumor ablation (e.g., for patients being unfit for surgery), and reduction of pain via plexus neurolysis. Furthermore, endoscopy may be used for targeting: EUS-guided fiducial placement may be performed to guide stereotactic radiation therapy.

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References

  1. Adler DG, Baron TH (2002) Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol 97:72–78

    Article  PubMed  Google Scholar 

  2. Andersen JR, Sørensen SM, Kruse A et al (1989) Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 30:1132–1135

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Arcidiacono PG, Calori G, Carrara S et al (2011) Celiac plexus block for pancreatic cancer pain in adults. Cochrane Database Syst Rev:CD007519

    Google Scholar 

  4. Artifon EL, Sakai P, Cunha JE et al (2006) Surgery or endoscopy for palliation of biliary obstruction due to metastatic pancreatic cancer. Am J Gastroenterol 101:2031–2037

    Article  PubMed  Google Scholar 

  5. ASGE Standards of Practice Committee, Eloubeidi MA, Decker GA, Chandrasekhara V, Chathadi KV, Early DS, Evans JA, Fanelli RD, Fisher DA, Foley K, Hwang JH, Jue TL, Lightdale JR, Pasha SF, Saltzman JR, Sharaf R, Shergill AK, Cash BD, JM DW (2016) The role of endoscopy in the evaluation and management of patients with solid pancreatic neoplasia. Gastrointest Endosc 83:17–28

    Article  Google Scholar 

  6. ASGE Technology Committee, Navaneethan U, Thosani N et al (2017) Radiofrequency ablation devices. VideoGIE 2:252–259

    Article  PubMed Central  Google Scholar 

  7. Bang JY, Navaneethan U, Hasan M, Hawes R, Varadarajulu S (2018) Stent placement by EUS or ERCP for primary biliary decompression in pancreatic cancer: a randomized trial (with videos). Gastrointest Endosc 88:9–17

    Article  PubMed  Google Scholar 

  8. Baron TH (2006) Palliation of malignant obstructive jaundice. Gastroenterol Clin N Am 35:101–112

    Article  Google Scholar 

  9. Baron TH (2010) Management of Simultaneous Biliary and Duodenal Obstruction: the endoscopic perspective. Gut Liver 4(Suppl 1):S50–S56

    Article  PubMed  PubMed Central  Google Scholar 

  10. Baron TH, Kozarek RA (2010) Preoperative biliary stents in pancreatic cancer - proceed with caution. N Engl J Med 362:170–172

    Article  CAS  PubMed  Google Scholar 

  11. Bilchik AJ, Rose DM, Allegra DP, Bostick PJ, Hsueh E, Morton DL (1999) Radiofrequency ablation: a minimally invasive technique with multiple applications. Cancer J Sci Am 5:356–361

    CAS  PubMed  Google Scholar 

  12. Bliss LA, Eskander MF, Kent TS et al (2016) Early surgical bypass versus endoscopic stent placement in pancreatic cancer. HPB (Oxford) 18:671–677

    Article  Google Scholar 

  13. Chak A (2009) What is the evidence for EUS-guided celiac plexus block/−neurolysis? Gastrointest Endosc 69:S172–S173

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chen Y, Itoi T, Baron TH et al (2017) EUS-guided gastroenterostomy is comparable to enteral stenting with fewer re-interventions in malignant gastric outlet obstruction. Surg Endosc 31:2946–2952

    Article  PubMed  Google Scholar 

  15. Crippa S, Cirocchi R, Partelli S et al (2016) Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol 42:1278–1285

    Article  CAS  PubMed  Google Scholar 

  16. Davids PH, Groen AK, Rauws EA et al (1992) Randomised trial of selfexpanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340:1488–1492

    Article  CAS  PubMed  Google Scholar 

  17. De Lima SLA, Bustamante FAC, de Moura EGH et al (2015) Endoscopic palliative treatment versus surgical bypass in malignant low bile duct obstruction: a systematic review and meta-analysis. Int J Hepatobiliary Pancreat Dis 5:35–46

    Article  Google Scholar 

  18. Dumonceau JM, Tringali A, Papanikolaou IS, Blero D, Mangiavillano B, Schmidt A, Vanbiervliet G, Costamagna G, Devière J, García-Cano J, Gyökeres T, Hassan C, Prat F, Siersema PD, van Hooft JE (2018) Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline - updated October 2017. Endoscopy 50:910–930

    Article  PubMed  Google Scholar 

  19. Fabbri C, Luigiano C, Lisotti A et al (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. Fan WJ, Wu PH, Zhang L, Huang JH, Zhang FJ, Gu YK, Zhao M, Huang XL, Guo CY (2008) Radiofrequency ablation as a treatment for hilar cholangiocarcinoma. World J Gastroenterol 14:4540–4545

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fujii L, Clain JE, Morris JM et al (2012) Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis. Endoscopy 44(suppl 2):E265–E266

    PubMed  Google Scholar 

  22. GBD 2017 Pancreatic Cancer Collaborators (2019) The global, regional, and national burden of pancreatic cancer and its attributable risk factors in 195 countries and territories, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet Gastroenterol Hepatol 4:934–947

    Article  Google Scholar 

  23. Glazer ES, Hornbrook MC, Krouse RS (2014) A meta-analysis of randomized trials: immediate stent placement vs. surgical bypass in the palliative management of malignant biliary obstruction. J Pain Symptom Manag 47:307–314

    Article  Google Scholar 

  24. Hara K, Yamao K, Niwa Y, Sawaki A, Mizuno N, Hijioka S, Tajika M, Kawai H, Kondo S, Kobayashi Y, Matumoto K, Bhatia V, Shimizu Y, Ito A, Hirooka Y, Goto H (2011) Prospective clinical study of EUS-guided choledochoduodenostomy for malignant lower biliary tract obstruction. Am J Gastroenterol 106:1239–1245

    Article  PubMed  Google Scholar 

  25. Hara K, Yamao K, Hijioka S, Mizuno N, Imaoka H, Tajika M, Kondo S, Tanaka T, Haba S, Takeshi O, Nagashio Y, Obayashi T, Shinagawa A, Bhatia V, Shimizu Y, Goto H, Niwa Y (2013) Prospective clinical study of endoscopic ultrasound-guided choledocho-duodenostomy with direct metallic stent placement using a forward-viewing echoendoscope. Endoscopy 45:392–396

    Article  CAS  PubMed  Google Scholar 

  26. Hathorn KE, Bazarbashi AN, Sack JS, McCarty TR, Wang TJ, Chan WW, Thompson CC, Ryou M (2019) EUS-guided biliary drainage is equivalent to ERCP for primary treatment of malignant distal biliary obstruction: a systematic review and meta-analysis. Endosc Int Open 7:E1432–E1441

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hidalgo M (2010) Pancreatic cancer. N Engl J Med 362:1605–1617

    Article  CAS  PubMed  Google Scholar 

  28. Inamdar S, Slattery E, Bhalla R et al (2016) Comparison of adverse events for endoscopic vs percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort. JAMA Oncol 2:112–117

    Article  PubMed  Google Scholar 

  29. Isayama H, Kawabe T, Nakai Y et al (2006) Cholecystitis after metallic stent placement in patients with malignant distal biliary obstruction. Clin Gastroenterol Hepatol 4:1148–1153

    Article  PubMed  Google Scholar 

  30. Isenberg G, Gouma DJ, Pisters PW (2002) The on-going debate about perioperative biliary drainage in jaundiced patients undergoing pancreaticoduodenectomy. Gastrointest Endosc 56:310–315

    PubMed  Google Scholar 

  31. Itoi T, Itokawa F, Uraoka T et al (2013) Novel EUS-guided gastrojejunostomy technique using a new double-balloon enteric tube and lumen-apposing metal stent (with videos). Gastrointest Endosc 78:934–939

    Article  PubMed  Google Scholar 

  32. Itoi T, Ishii K, Ikeuchi N et al (2016) Prospective evaluation of endoscopic ultrasonography-guided double-balloon-occluded gastrojejunostomy bypass (EPASS) for malignant gastric outlet obstruction. Gut 65:193–195

    Article  PubMed  Google Scholar 

  33. Itoi T, Baron TH, Khashab MA et al (2017) Technical review of endoscopic ultrasonography-guided gastroenterostomy in 2017. Dig Endosc 29:495–502

    Article  PubMed  Google Scholar 

  34. Jeurnink SM, Steyerberg EW, van Hooft JE et al (2010) Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc 71:490–499

    Article  PubMed  Google Scholar 

  35. Kaassis M, Boyer J, Dumas R et al (2003) Plastic or metal stents for malignant stricture of the common bile duct? Results of a randomized prospective study. Gastrointest Endosc 57:178–182

    Article  PubMed  Google Scholar 

  36. Kaufman M, Singh G, Das S et al (2010) 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

    Article  PubMed  Google Scholar 

  37. Kawakubo K, Isayama H, Nakai Y et al (2012) Risk factors for pancreatitis following transpapillary self-expandable metal stent placement. Surg Endosc 26:771–776

    Article  PubMed  Google Scholar 

  38. Kawakubo K, Kawakami H, Kuwatani M, Kubota Y, Kawahata S, Kubo K, Sakamoto N (2016) Endoscopic ultrasound-guided choledochoduodenostomy vs. transpapillary stenting for distal biliary obstruction. Endoscopy 48:164–169

    Article  PubMed  Google Scholar 

  39. Khan MA, Akbar A, Baron TH et al (2016) Endoscopic ultrasound-guided biliary drainage: a systematic review and meta-analysis. Dig Dis Sci 61:684–703

    Article  PubMed  Google Scholar 

  40. Khashab MA (2019) EUS-guided Gastroenterostomy vs duodenal stenting for the palliation of malignant gastric outlet obstruction. Gastroenterol Hepatol (NY) 15:323–325

    Google Scholar 

  41. Khashab MA, Kumbhari V, Grimm IS et al (2015) EUS-guided gastroenterostomy: the first U.S. clinical experience (with video). Gastrointest Endosc 82:932–938

    Article  PubMed  Google Scholar 

  42. Khashab MA, Bukhari M, Baron TH et al (2017) International multicenter comparative trial of endoscopic ultrasonography-guided gastroenterostomy versus surgical gastrojejunostomy for the treatment of malignant gastric outlet obstruction. Endosc Int Open 5:E275–E281

    Article  PubMed  PubMed Central  Google Scholar 

  43. Larghi A, Rizzatti G, Rimbaş M, Crino SF, Gasbarrini A, Costamagna G (2019) EUS-guided radiofrequency ablation as an alternative to surgery for pancreatic neuroendocrine neoplasms: who should we treat? Endosc Ultrasound 8:220–226

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lavu H, Lengel HB, Sell NM, Baiocco JA, Kennedy EP, Yeo TP, Burrell SA, Winter JM, Hegarty S, Leiby BE, Yeo CJ (2015) A prospective, randomized, double-blind, placebo controlled trial on the efficacy of ethanol celiac plexus neurolysis in patients with operable pancreatic and periampullary adenocarcinoma. J Am Coll Surg 220:497–508

    Article  PubMed  Google Scholar 

  45. Lawrence C, Romagnuolo J, Payne KM et al (2010) Low symptomatic premature stent occlusion of multiple plastic stents for benign biliary strictures: comparing standard and prolonged stent change intervals. Gastrointest Endosc 72:558–563

    Article  PubMed  Google Scholar 

  46. Lennon AM, Newman N, Makary MA et al (2010) EUS-guided tattooing before laparoscopic distal pancreatic resection (with video). Gastrointest Endosc 72:1089–1094

    Article  PubMed  Google Scholar 

  47. Ligresti D, Amata M, Barresi L, Traina M, Tarantino I (2018) EUS-guided radiofrequency ablation of small pancreatic adenocarcinoma: a new therapeutic option for patients unfit for surgery. VideoGIE 4:29–31

    Article  PubMed  PubMed Central  Google Scholar 

  48. Loeve US, Mortensen MB (2013) Lethal necrosis and perforation of the stomach and the aorta after multiple EUS-guided celiac plexus neurolysis procedures in a patient with chronic pancreatitis. Gastrointest Endosc 77:151–152

    Article  PubMed  Google Scholar 

  49. Luz LP, Al-Haddad MA, Sey MS, DeWitt JM (2014) Applications of endoscopic ultrasound in pancreatic cancer. World J Gastroenterol 20:7808–7818

    Article  PubMed  PubMed Central  Google Scholar 

  50. Mehta S, Hindmarsh A, Cheong E et al (2006) Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc 20:239–242

    Article  CAS  PubMed  Google Scholar 

  51. Miller CS, Barkun AN, Martel M, Chen YI (2019) Endoscopic ultrasound-guided biliary drainage for distal malignant obstruction: a systematic review and meta-analysis of randomized trials. Endosc Int Open 7:E1563–E1573

    Article  PubMed  PubMed Central  Google Scholar 

  52. Minicozzi P, Cassetti T, Vener C, Sant M (2018) Analysis of incidence, mortality and survival for pancreatic and biliary tract cancers across Europe, with assessment of influence of revised European age standardisation on estimates. Cancer Epidemiol 55:52–60

    Article  PubMed  Google Scholar 

  53. Miura F, Sano K, Wada K et al (2017) Prognostic impact of type of preopera- tive biliary drainage in patients with distal cholangiocarcinoma. Am J Surg 214:256–261

    Article  PubMed  Google Scholar 

  54. Moole H, Bechtold ML, Forcione D et al (2017) A meta-analysis and systematic review: success of endoscopic ultrasound guided biliary stenting in patients with inoperable malignant biliary strictures and a failed ERCP. Medicine 96:e5154

    Article  PubMed  PubMed Central  Google Scholar 

  55. Moss AC, Morris E, Mac Mathuna P (2006) Palliative biliary stents for obstructing pancreatic carcinoma. Cochrane Database Syst Rev:CD004200

    Google Scholar 

  56. Nabi Z, Reddy DN (2019) Endoscopic palliation for biliary and pancreatic malignancies: recent advances. Clin Endosc 52:226–234

    Article  PubMed  PubMed Central  Google Scholar 

  57. Nagels W, Pease N, Bekkering G et al (2013) Celiac plexus neurolysis for abdominal cancer pain: a systematic review. Pain Med 14:1140–1163

    Article  PubMed  Google Scholar 

  58. Nakai Y, Isayama H, Kawakami H, Ishiwatari H, Kitano M, Ito Y, Yasuda I, Kato H, Matsubara S, Irisawa A, Itoi T (2019) Prospective multicenter study of primary EUS-guided choledochoduodenostomy using a covered metal stent. Endosc Ultrasound 8:111–117

    Article  PubMed  Google Scholar 

  59. Newman NA, Lennon AM, Edil BH, Gilson MM, Giday SA, Canto MI, Schulick RD, Makary MM (2010) Preoperative endoscopic tattooing of pancreatic body and tail lesions decreases operative time for laparoscopic distal Pancreatectomy. Surgery 148:371–377

    Article  PubMed  Google Scholar 

  60. Paiella S, De Pastena M, D’Onofrio M et al (2018) Palliative therapy in pancreatic cancer-interventional treatment with radiofrequency ablation/irreversible electroporation. Transl Gastroenterol Hepatol 3:80

    Article  PubMed  PubMed Central  Google Scholar 

  61. Paik WH, Lee TH, Park DH, Choi JH, Kim SO, Jang S, Kim DU, Shim JH, Song TJ, Lee SS, Seo DW, Lee SK, Kim MH (2018) EUS-guided biliary drainage versus ERCP for the primary palliation of malignant biliary obstruction: a multicenter randomized clinical trial. Am J Gastroenterol 113:987–997

    Article  PubMed  Google Scholar 

  62. Park WG, Yan BM, Schellenberg D et al (2010) EUS-guided gold fiducial insertion for image-guided radiation therapy for pancreatic cancer: 50 successful cases without fluoroscopy. Gastrointest Endosc 71:513–518

    Article  PubMed  Google Scholar 

  63. Park JK, Woo YS, Noh DH, Yang JI, Bae SY, Yun HS, Lee JK, Lee KT, Lee KH (2018) Efficacy of EUS-guided and ERCP-guided biliary drainage for malignant biliary obstruction: prospective randomized controlled study. Gastrointest Endosc 88:277–282

    Article  PubMed  Google Scholar 

  64. Perez-Miranda M, Tyberg A, Poletto D et al (2017) EUS-guided gastrojejunostomy versus laparoscopic gastrojejunostomy: an international collaborative study. J Clin Gastroenterol 51:896–899

    Article  PubMed  Google Scholar 

  65. Pishvaian AC, Collins B, Gagnon G, Ahlawat S, Haddad NG (2006) EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 64:412–417

    Article  PubMed  Google Scholar 

  66. Rossi S, Viera FT, Ghittoni G et al (2014) Radiofrequency ablation of pancreatic neuroendocrine tumors: a pilot study of feasibility, efficacy, and safety. Pancreas 43:938–945

    Article  PubMed  Google Scholar 

  67. Sanders MK, Moser AJ, Khalid A et al (2010) EUS-guided fiducial placement for stereotactic body radiotherapy in locally advanced and recurrent pancreatic carcinoma. Gastrointest Endosc 71:1178–1184

    Article  PubMed  Google Scholar 

  68. Song TJ, Lee JH, Lee SS et al (2016) Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection. Gastrointest Endosc 84:814–821

    Article  PubMed  Google Scholar 

  69. Steel AW, Postgate AJ, Khorsandi S, Nicholls J, Jiao L, Vlavianos P, Habib N, Westaby D (2011) Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc 73:149–153

    Article  PubMed  Google Scholar 

  70. Strom TJ, Klapman JB, Springett GM et al (2015) Comparative long-term outcomes of upfront resected pancreatic cancer after preoperative biliary drainage. Surg Endosc 29:3273–3281

    Article  PubMed  PubMed Central  Google Scholar 

  71. Taylor MC, McLeod RS, Langer B (2000) Biliary stenting versus bypass surgery for the palliation of malignant distal bile duct obstruction: a meta-analysis. Liver Transpl 6:302–308

    Article  CAS  PubMed  Google Scholar 

  72. Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB 3rd, Binder E, Cardin DB, Cha C, Chiorean EG, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O’Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S (2017) Pancreatic adenocarcinoma, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw 15(8):1028–1061

    Article  Google Scholar 

  73. Teoh AYB, Dhir V, Kida M, Yasuda I, Jin ZD, Seo DW, Almadi M, Ang TL, Hara K, Hilmi I, Itoi T, Lakhtakia S, Matsuda K, Pausawasdi N, Puri R, Tang RS, Wang HP, Yang AM, Hawes R, Varadarajulu S, Yasuda K, Ho LKY (2018) Consensus guidelines on the optimal management in interventional EUS procedures: results from the Asian EUS group RAND/UCLA expert panel. Gut 67:1209–1228

    Article  PubMed  Google Scholar 

  74. Uemura K, Murakami Y, Satoi S et al (2015) Impact of preoperative biliary drainage on long-term survival in resected pancreatic ductal adeno- carcinoma: a multicenter observational study. Ann Surg Oncol 22(Suppl. 03):1238–1246

    Article  Google Scholar 

  75. Van der Gaag NA, Rauws EA, van Eijck CH et al (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362:129–137

    Article  PubMed  Google Scholar 

  76. Wang AY, Yachimski PS (2018) Endoscopic Management of Pancreatobiliary Neoplasms. Gastroenterology 154:1947–1963

    Article  PubMed  Google Scholar 

  77. Wang K, Zhu J, Xing L et al (2016) Assessment of efficacy and safety of EUS- guided biliary drainage: a systematic review. Gastrointest Endosc 83:1218–1227

    Article  PubMed  Google Scholar 

  78. Will U, Fueldner F, Kern C, Meyer F (2015) EUS-guided bile duct drainage (EUBD) in 95 patients. Ultraschall Med 36:276–283

    CAS  PubMed  Google Scholar 

  79. Wu Y, Tang Z, Fang H et al (2006) High operative risk of cool-tip radiofrequency ablation for unresectable pancreatic head cancer. J Surg Oncol 94:392–395

    Article  PubMed  Google Scholar 

  80. Yamaguchi K, Okusaka T, Shimizu K, Furuse J, Ito Y, Hanada K, Shimosegawa T, Okazaki K (2017) Committee for revision of clinical guidelines for pancreatic cancer of the Japan Pancreas Society. Clinical practice guidelines for pancreatic Cancer 2016 from the Japan pancreas society: a synopsis. Pancreas 46:595–604

    Article  PubMed  Google Scholar 

  81. Yamao K, Kitano M, Takenaka M, Minaga K, Sakurai T, Watanabe T, Kayahara T, Yoshikawa T, Yamashita Y, Asada M, Okabe Y, Hanada K, Chiba Y, Kudo M (2018) Outcomes of endoscopic biliary drainage in pancreatic cancer patients with an indwelling gastroduodenal stent: a multicenter cohort study in West Japan. Gastrointest Endosc 88:66–75

    Article  PubMed  Google Scholar 

  82. Yeoh KG, Zimmerman MJ, Cunningham JT et al (1999) Comparative costs of metal versus plastic biliary stent strategies for malignant obstructive jaundice by decision analysis. Gastrointest Endosc 49:466–471

    Article  CAS  PubMed  Google Scholar 

  83. Zheng B, Wang X, Ma B, Tian J, Jiang L, Yang K (2012) Endoscopic stenting versus gastrojejunostomy for palliation of malignant gastric outlet obstruction. Dig Endosc 24:71–78

    Article  PubMed  Google Scholar 

  84. Zhong W, Yu Z, Zeng JX et al (2014) Celiac plexus block for treatment of pain associated with pancreatic cancer: a meta-analysis. Pain Pract 14:43–51

    Article  PubMed  Google Scholar 

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  1. Department of Medicine I, Josephs-Hospital Warendorf, Academic Teaching Hospital, University of Muenster, Warendorf, Germany

    Dirk Domagk

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  1. Dirk Domagk
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  1. Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University, MILANO, Milano, Italy

    Pier Alberto Testoni

  2. Digestive Diseases Center, Showa University Hospital, Tokyo, Japan

    Haruhiro Inoue

  3. Div. of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA

    Michael B. Wallace

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  1. Gastrointestinal Endoscopy Unit, Vita‐Salute San Raffaele University, Milan, Italy

    Pier Alberto Testoni

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Domagk, D. (2021). Treatment of Pancreatic Cancer. In: Testoni, P.A., Inoue, H., Wallace, M.B. (eds) Gastrointestinal and Pancreatico-Biliary Diseases: Advanced Diagnostic and Therapeutic Endoscopy. Springer, Cham. https://doi.org/10.1007/978-3-030-29964-4_100-1

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