Skip to main content
SpringerLink
Log in

Endoscopic Therapies for Palliation of Gastrointestinal Malignancies

  • Chapter
  • First Online:
Essentials of Palliative Care

  • 3147 Accesses

Abstract

Malignant diseases of the gastrointestinal tract are often diagnosed at advanced stages when surgical options are limited. Due to involvement of luminal structures, obstructive symptoms are frequent. From a gastrointestinal standpoint, there are numerous endoscopic therapies available for palliative purposes to improve quality of life and short-term survival. Our experience with these techniques has improved with time and has provided alternatives to surgical or interventional radiology procedures. Furthermore, advances in imaging have allowed for better localization and planning of procedures.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Rupinski M, Zagorowicz E, Regula J, Fijuth J, Kraszewska E, Polkowski M, Wronska E, Butruk E. Randomized comparison of three palliative regimens including brachytherapy, photodynamic therapy, and APC in patients with malignant dysphagia (CONSORT 1a). Am J Gastroenterol. 2011. doi:10.1038/ajg.2011.178.

  2. Akhtar K, Byrne JP, Bancewicz J, Attwood SE. Argon beam plasma coagulation in the management of cancer of the esophagus and stomach. Surg Endosc. 2000;14(12):1127–30.

    Article  PubMed  CAS  Google Scholar 

  3. Vanbiervliet G, Piche T, Caroli-Bosc FX, Dumas R, Peten EP, Huet PM, Tran A, Demarquay JF. Endoscopic argon plasma trimming of biliary and gastrointestinal metallic stents. Endoscopy. 2005;37(5):434–8.

    Article  PubMed  CAS  Google Scholar 

  4. Marcon NE. Photodynamic therapy and cancer of the esophagus. Semin Oncol. 1994;21(6 Suppl 15):20.

    PubMed  CAS  Google Scholar 

  5. Lightdale CJ, Heier SK, Marcon NE, McCaughan Jr JS, Gerdes H, Overholt BF, Sivak Jr MJ, Steigmann GV, Nava HR. Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial. Gastrointest Endosc. 1995;42(6):507.

    Article  PubMed  CAS  Google Scholar 

  6. Mellow MH, et al. Endoscopic laser therapy for malignancies affecting the esophagus and gastroesophageal junction. Analysis of technical and functional efficacy. Arch Intern Med. 1985;145(8):1443.

    Article  PubMed  CAS  Google Scholar 

  7. Haddad NG, et al. Endoscopic laser therapy for esophageal cancer. Gastrointest Endosc Clin N Am. 1994;4(4):863.

    PubMed  CAS  Google Scholar 

  8. Boyce HW. Pallation of dysphagia of esophageal cancer by endoscopic lumen restoration techniques. Cancer Control. 1999;6(1):73.

    PubMed  Google Scholar 

  9. Hernandez HW, et al. Comparison among the perforation rates of Maloney, balloon, and savary dilation of esophageal strictures. Gastrointest Endosc. 2000;51:460.

    Article  PubMed  CAS  Google Scholar 

  10. Dobrucali A, Caglar E. Palliation of malignant esophageal obstruction and fistulas with self expandable metallic stents. World J Gastroenterol. 2010;16(45):5739–45.

    Article  PubMed  Google Scholar 

  11. Dormann A, Meisner S, Verin N, Wenk Lang A. Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy. 2004;36(6):543–50.

    Article  PubMed  CAS  Google Scholar 

  12. van Jeurnink SM, Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;8(7):18.

    Article  Google Scholar 

  13. Repici A, et al. Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc. 2007;66(5):940.

    Article  PubMed  Google Scholar 

  14. Lo SK. Metallic stenting for colorectal obstruction. Gastrointest Endosc Clin N Am. 1999;9(3):459.

    PubMed  CAS  Google Scholar 

  15. van Hooft JE, Fockens P, Marinelli AW, Timmer R, van Berkel AM, Bossuyt PM, Bemelman WA, Dutch Colorectal Stent Group. Early closure of a multicenter randomized clinical trial of endoscopic stenting versus surgery for stage IV left-sided colorectal cancer. Endoscopy. 2008;40(3):184.

    Article  PubMed  Google Scholar 

  16. Lee HJ, Hong SP, Cheon JH, Kim TI, Min BS, Kim NK, Kim WH. Long-term outcome of palliative therapy for malignant colorectal obstruction in patients with unresectable metastatic colorectal cancers: endoscopic stenting versus surgery. Gastrointest Endosc. 2011;73(3):535–42.

    Article  PubMed  Google Scholar 

  17. Shaib YH, Davila JA, El-Serag HB. The epidemiology of pancreatic cancer in the United States: changes below the surface. Aliment Pharmacol Ther. 2006;24(1):87.

    Article  PubMed  CAS  Google Scholar 

  18. Weber A, Mittermeyer T, Wagenpfeil S, Schmid RM, Prinz C. Self-expanding metal stents versus polyethylene stents for palliative treatment in patients with advanced pancreatic cancer. Pancreas. 2009;38(1):e7–12.

    Article  PubMed  CAS  Google Scholar 

  19. 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. 2004;53(5):729–34.

    Article  PubMed  CAS  Google Scholar 

  20. Saleem A, Leggett CL, Murad MH, Baron TH. Meta-analysis of randomized trials comparing the patency of covered and uncovered self-expandable metal stents for palliation of distal malignant bile duct obstruction. Gastrointest Endosc. 2011;74(2):321–7.

    Article  PubMed  Google Scholar 

  21. Rogart JN, Boghos A, Rossi F, Al-Hashem H, Siddiqui UD, Jamidar P, Aslanian H. Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center. Gastrointest Endosc. 2008;68(4):676–82.

    Article  PubMed  Google Scholar 

  22. van der Gaag NA, Rauws EA, van Eijck CH, Bruno MJ, van der Harst E, Kubben FJ, Gerritsen JJ, Greve JW, Gerhards MF, de Hingh IH, Klinkenbijl JH, Nio CY, de Castro SM, Busch OR, van Gulik TM, Bossuyt PM, Gouma DJ. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362(2):129–37.

    Article  PubMed  Google Scholar 

  23. Moss AC, Morris E, Leyden J, MacMathuna P. Malignant distal biliary obstruction: a systematic review and meta-analysis of endoscopic and surgical bypass results. Cancer Treat Rev. 2007;33(2):213.

    Article  PubMed  Google Scholar 

  24. Chen VK, Arguedas MR, Baron TH. Expandable metal biliary stents before pancreaticoduodenectomy for pancreatic cancer: a Monte-Carlo decision analysis. Clin Gastroenterol Hepatol. 2005;3(12):1229.

    Article  PubMed  Google Scholar 

  25. Raju RP, Jaganmohan SR, Ross WA, Davila ML, Javle M, Raju GS, Lee JH. Optimum palliation of inoperable hilary cholangiocarcinoma: comparative assessment of the efficacy of plastic and self-expanding metal stents. Dig Dis Sci. 2011;56(5):1557–64.

    Article  PubMed  Google Scholar 

  26. Perdue DG, Freeman ML, DiSario JA, Nelson DB, Fennerty MB, Lee JG, Overby CS, Ryan ME, Bochna GS, Snady HW, Moore JP, ERCP Outcome Study ERCOST Group. Plastic versus self-expandable metallic stents for malignant hilar biliary obstruction: a prospective multicenter observational cohort study. J Clin Gastroenterol. 2008;42(9):1040–6.

    Article  PubMed  Google Scholar 

  27. Larghi A, Tringali A, Lecca PG, Giordano M, Costamagna G. Management of hilar biliary strictures. Am J Gastroenterol. 2008;103(2):458.

    Article  PubMed  Google Scholar 

  28. Richter JA, Kahaleh M. Photodynamic therapy: palliation and endoscopic technique in cholangiocarcinoma. World J Gastrointest Endosc. 2010;2(11):357–61.

    Article  PubMed  Google Scholar 

  29. Steel AW, Postgate AJ, Khorsandi S, Nicholls J, Jiao L, Vlavianos P, Habib N, Westaby D. Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction. Gastrointest Endosc. 2011;73(1):149–53.

    Article  PubMed  Google Scholar 

  30. Levy MJ, Wiersema MJ. EUS-guided celiac plexus neurolysis and celiac plexus block. Gastrointest Endosc. 2003;57(7):923–30.

    Article  PubMed  Google Scholar 

  31. Puli SR, Reddy JB, Bechtold ML, Antillon MR, Brugge WR. EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: a meta-analysis and systematic review. Dig Dis Sci. 2009;54(11):2330.

    Article  PubMed  Google Scholar 

  32. Levy MJ, Topazian MD, Wiersema MJ, Clain JE, Rajan E, Wang KK, de la Mora JG, Gleeson FC, Pearson RK, Pelaez MC, Petersen BT, Vege SS, Chari ST. Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block. Am J Gastroenterol. 2008;103(1):98–103.

    Article  PubMed  Google Scholar 

  33. Finocchiaro C, Galletti R, Rovera G, Ferrari A, Todros L, Vuolo A, Balzola F. Percutaneous endoscopic gastrostomy: a long-term follow-up. Nutrition. 1997;13(6):520–3.

    Article  PubMed  CAS  Google Scholar 

  34. Montecalvo MA, Steger KA, Farber HW, Smith BF, Dennis RC, Fitzpatrick GF, Pollack SD, Korsberg TZ, Birkett DH, Hirsch EF, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings. The Critical Care Research Team. Crit Care Med. 1992;20(10):1377–87.

    Article  PubMed  CAS  Google Scholar 

  35. Holm AN, Baron TH. Palliative use of percutaneous endoscopic gastrostomy and percutaneous endoscopic cecostomy tubes. Gastrointest Endosc Clin N Am. 2007;17(4):795–803.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, 1080 LMP, New Haven, CT, 06520-8019, USA

    Henry C. Ho M.D.

  2. Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL, USA

    Uzma D. Siddiqui M.D.

Authors
  1. Henry C. Ho M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Uzma D. Siddiqui M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry C. Ho M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Photodynamic therapy (PDT) is sometimes used for tissue ablation to palliate obstructing esophageal cancers. Two potentially debilitating side effects which have limited the widespread use of PDT include:

    1. (a)

      Nephrotoxicity and tinnitus

    2. (b)

      Diarrhea and vomiting

    3. (c)

      Photosensitivity and stricture

    4. (d)

      Headache and diarrhea

  2. 2.

    All of the statements below are true regarding endoscopic dilation of obstruction due to esophageal cancer except:

    1. (a)

      Can be complicated by perforation

    2. (b)

      Usually done through the scope balloon

    3. (c)

      Typically provides long-lasting relief of dysphagia

    4. (d)

      Often does not provide palliation and patients require endoscopic stent placement

  3. 3.

    Self-expandable metal stents (SEMS) are used in the biliary tract for palliation of malignant obstruction. They can be covered, partially covered, or uncovered (bare). Covered SEMS are associated with:

    1. (a)

      Increased obstruction rates

    2. (b)

      Unacceptable rates of deployment failure

    3. (c)

      Increased perforation rates

    4. (d)

      Increased migration rates

  4. 4.

    Gastroduodenal obstruction (e.g., due to pancreatic head cancer) can be treated with enteral stent placement. The following should be considered prior to enteral stent placement:

    1. (a)

      Status of the biliary tract to assess need for biliary stenting

    2. (b)

      Helicobacter pylori status

    3. (c)

      PEG placement for tube feeds

    4. (d)

      Stent placement only if the endoscope can be passed beyond the duodenal obstruction

  5. 5.

    Several considerations should be made prior to plastic versus metal biliary stenting for malignant obstruction. All of the following would be included in the decision making process except:

    1. (a)

      Survival

    2. (b)

      Resectability

    3. (c)

      Location of stricture

    4. (d)

      Cost

    5. (e)

      Age of patient

  6. 6.

    In malignant colonic obstruction, one should always dilate the stricture prior to colonic metal stent placement

    1. (a)

      True

    2. (b)

      False

Answers

  1. 1.

    (c)

  2. 2.

    (c)

  3. 3.

    (d)

  4. 4.

    (a)

  5. 5.

    (e)

  6. 6.

    (b)

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Ho, H.C., Siddiqui, U.D. (2013). Endoscopic Therapies for Palliation of Gastrointestinal Malignancies. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_19

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation