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These patients are often presented with malignant biliary obstruction (MBO) and gastric outlet obstruction (GOO). In these cases, palliative management is aimed to alleviate symptoms, enhance quality of life, and facilitate subsequent chemotherapy. Currently, neoadjuvant chemotherapy is frequently used in both borderline resectable and resectable pancreatic cancer, necessitating effective biliary and gastrointestinal drainage in a growing number of patients. Traditionally, surgical bypass was the gold standard, performed via either a minimally invasive or open approach. However, notable progress has emerged in developing endoscopic techniques, such as endoscopic retrograde cholangiopancreatography (ERCP) stenting for MBO and endoscopic enteral stenting for GOO. While these procedures provide rapid symptom relief, they are associated with higher stent dysfunction rates and more frequent re\u2010intervention needs. When ERCP fails, percutaneous transhepatic biliary drainage is a widely accepted alternative for MBO. Endoscopic ultrasound (EUS)\u2010guided techniques, including EUS\u2010guided biliary drainage and EUS\u2010guided gastroenterostomy, have recently gained prominence. Emerging clinical data suggest that these methods may be superior, potentially becoming the preferred first\u2010line palliative treatment for unresectable pancreatic cancer. This review will summarize the current evidence on managing MBO and GOO in patients with pancreatic cancer.<\/jats:p>","DOI":"10.1002\/ags3.12902","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T22:58:51Z","timestamp":1735253931000},"page":"218-225","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Palliative management for malignant biliary obstruction and gastric outlet obstruction from pancreatic cancer"],"prefix":"10.1002","volume":"9","author":[{"given":"Pengfei","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine  Baltimore Maryland USA"},{"name":"Pancreas Center The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Pancreas Institute of Nanjing Medical University  Nanjing 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