Endoscopic management of pancreatic cancer

Endoscopic treatment of pancreatic malignancy can be considered as an alternative treatment option in inoperable patients. Endoscopic retrograde cholangio-pancreatography (ERCP) plays a key role, allowing diagnosis, collection of cytologic, biopsy specimens, and insertion of biliary and pancreatic stents. A major problem is the patency of plastic stents that will eventually clog on average after 3 to 4 months. Self-expandable metallic stents have longer patency, but they can also become occluded by tumor ingrowth or overgrowth. Furthermore, metallic stents are much more expensive and their uses may be considered in patients with longer life expectancy. ERCP can be performed on an outpatient basis in selected patients, reducing costs related to hospitalization. A team approach is mandatory to obtain the best results.