Endoscopic Palliation in Pancreatic Cancer: AMJ, March 2026

This article reviews the endoscopic approach to palliation in pancreatic cancer, emphasising that most patients present with unresectable or metastatic disease, so symptom control becomes central to care. Because of the pancreas’ location, tumour growth commonly leads to biliary obstruction, gastric outlet obstruction (GOO), and pain from neural invasion.

A major focus is the management of malignant biliary obstruction, which occurs in a large proportion of patients and can cause jaundice, pruritus, nausea, malabsorption, cholangitis, and delay in chemotherapy. The article highlights that biliary decompression is now commonly achieved using endoscopic or percutaneous techniques rather than surgery.

The main drainage strategies:

ERCP with placement of a plastic stent or self-expandable metal stent (SEMS) directly across the obstructed common bile duct.

EUS-guided rendezvous technique, where a guidewire is passed into the bile duct and through the papilla to facilitate ERCP.

EUS-guided biliary drainage (EUS-BD), which creates a new tract for bile drainage above the obstruction.

EUS-HGS (hepaticogastrostomy), where a biliary SEMS drains the left intrahepatic duct into the stomach.

EUS-CDS (choledochoduodenostomy), where a biliary SEMS or lumen-apposing metal stent drains the common bile duct into the duodenum.

EUS-GBD (gallbladder drainage), where a lumen-apposing metal stent drains the gallbladder into the stomach or duodenum.

Percutaneous transhepatic biliary drainage (PTBD) as an external/internal catheter-based option.

The article also notes increasing use of preemptive biliary drainage when EUS-guided tissue diagnosis shows impending obstruction. Overall, the message is that endoscopic palliation has largely replaced surgical palliation, offering effective, less invasive relief of major pancreatic cancer complications.