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| 1 | Malignant biliary obstruction:From palliation to treatment显示文摘Malignant obstruction of the bile duct from cholan-giocarcinoma,pancreatic adenocarcinoma,or other tumors is a common problem which may cause debilitating symptoms and increase the risk of subsequent surgery.The optimal treatment-including the decision whether to treat prior to resection-depends on the type of malignancy,as well as the stage of disease.Preoperative biliary drainage is generally discouraged due to the risk of infectious complications,though some situations may benefit.Patients who require neoadjuvant therapy will require decompression for the prolonged period until attempted surgical cure.For pancreatic cancer patients,self-expanding metallic stents are superior to plastic stents for achieving lasting decompression without stent occlusion.For cholangiocarcinoma patients,treatment with percutaneous methods or nasobiliary drainage may be superior to endoscopic stent placement,with less risk of infectious complications or failure.For patients of either malignancy who have advanced disease with palliative goals only,the choice of stent for endoscopic decompression depends on estimated survival,with plastic stents favored for survival of < 4 mo.New endoscopic techniques may actually extend stent patency and patient survival for these patients by achieving local control of the obstructing tumor.Both photodynamic therapy and radiofrequency ablation may play a role in extending survival of patients with malignant biliary obstruction. | Brian R Boulay Aleksandr Birg | 2016 | World Journal of Gastrointestinal Oncology2016，8，6： | 24 |
| 2 | Endoscopic palliation of malignant biliary stricture显示文摘Malignant biliary strictures often present late after the window for curative resection has elapsed. In such patients, the goal of therapy is typically focused on palliation. While historically, palliative measures were performed surgically, the advent of endoscopic intervention offers minimally invasive options to provide relief of symptoms, improve quality of life, and in some cases, increase survival of these patients. Some of these therapies, such as endoscopic biliary decompression, have become mainstays of treatment for decades, whereas newer modalities, including radiofrequency ablation, and photodynamic therapy offer additional options for patients with incurable biliary malignancies. | Sanjay M Salgado Monica Gaidhane Michel Kahaleh | 2016 | World Journal of Gastrointestinal Oncology2016，8，3： | 3 |
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