{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:53:13Z","timestamp":1791309193984,"version":"4.3.1"},"reference-count":87,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,3,26]],"date-time":"2022-03-26T00:00:00Z","timestamp":1648252800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Gallbladder cancer is a rare malignancy burdened by poor prognosis with an estimated 5-year survival of 5% to 13% due to late presentation, early infiltration of surrounding tissues, and lack of successful treatments. The only curative approach is surgery; however, more than 50% of cases are unresectable at the time of diagnosis. Endoscopy represents, together with surgery and chemotherapy, an available palliative option in advanced gallbladder cancers not eligible for curative treatments. Cholangitis, jaundice, gastric outlet obstruction, and pain are common complications of advanced gallbladder cancer that may need endoscopic management in order to improve the overall survival and the patients\u2019 quality of life. Endoscopic biliary drainage is frequently performed to manage cholangitis and jaundice. ERCP is generally the preferred technique allowing the placement of a plastic stent or a self-expandable metal stent depending on the singular clinical case. EUS-guided biliary drainage is an available alternative for patients not amenable to ERCP drainage (e.g., altered anatomy). Gastric outlet obstruction is another rare complication of gallbladder malignancy growing in contact with the duodenal wall and causing its compression. Endoscopy is a less invasive alternative to surgery, offering different options such as an intraluminal self-expandable metal stent or EUS-guided gastroenteroanastomosis. Abdominal pain associated with cancer progression is generally managed with medical treatments; however, for incoercible pain, EUS-guided celiac plexus neurolysis has been described as an effective and safe treatment. Locoregional treatments, such as radiofrequency ablation (RFA), photodynamic therapy (PDT), and intraluminal brachytherapy (IBT), have been described in the control of disease progression; however, their role in daily clinical practice has not been established yet. The aim of this study is to perform a review of the literature in order to assess the role of endoscopy and the available techniques in the palliative therapy of advanced gallbladder malignancy.<\/jats:p>","DOI":"10.3390\/cancers14071686","type":"journal-article","created":{"date-parts":[[2022,3,27]],"date-time":"2022-03-27T21:27:51Z","timestamp":1648416471000},"page":"1686","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Palliation in Gallbladder Cancer: The Role of Gastrointestinal Endoscopy"],"prefix":"10.3390","volume":"14","author":[{"given":"Tommaso","family":"Schepis","sequence":"first","affiliation":[{"name":"Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8194-2670","authenticated-orcid":false,"given":"Ivo","family":"Bo\u0161koski","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy"},{"name":"Centre for Endoscopic Research, Therapeutics and Training (CERTT), Universit\u00e0 Cattolica del Sacro Cuore di Roma, Largo F. Vito, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9614-3449","authenticated-orcid":false,"given":"Andrea","family":"Tringali","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy"},{"name":"Centre for Endoscopic Research, Therapeutics and Training (CERTT), Universit\u00e0 Cattolica del Sacro Cuore di Roma, Largo F. Vito, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1960-5176","authenticated-orcid":false,"given":"Vincenzo","family":"Bove","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy"},{"name":"Centre for Endoscopic Research, Therapeutics and Training (CERTT), Universit\u00e0 Cattolica del Sacro Cuore di Roma, Largo F. Vito, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8100-2731","authenticated-orcid":false,"given":"Guido","family":"Costamagna","sequence":"additional","affiliation":[{"name":"Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy"},{"name":"Centre for Endoscopic Research, Therapeutics and Training (CERTT), Universit\u00e0 Cattolica del Sacro Cuore di Roma, Largo F. Vito, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1002\/1097-0142(19950101)75:1+<171::AID-CNCR2820751306>3.0.CO;2-2","article-title":"Liver, gallbladder, extrahepatic bile ducts, and pancreas","volume":"75","author":"Carriaga","year":"1995","journal-title":"Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1007\/s00261-020-02871-2","article-title":"Current update on gallbladder carcinoma","volume":"46","author":"Ganeshan","year":"2021","journal-title":"Abdom. Radiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1002\/1097-0142(19920915)70:6<1493::AID-CNCR2820700608>3.0.CO;2-U","article-title":"Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates","volume":"70","author":"Henson","year":"1992","journal-title":"Cancer"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Samuel, S., Mukherjee, S., Ammannagari, N., Pokuri, V.K., Kuvshinoff, B., Groman, A., LeVea, C.M., and Iyer, R. (2018). Clinicopathological characteristics and outcomes of rare histologic subtypes of gallbladder cancer over two decades: A population-based study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0198809"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.2214\/AJR.07.3599","article-title":"Gallbladder carcinoma update: Multimodality imaging evaluation, staging, and treatment options","volume":"191","author":"Furlan","year":"2008","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Giannis, D., Cerullo, M., Moris, D., Shah, K.N., Herbert, G., Zani, S., Blazer, D.G., Allen, P.J., and Lidsky, M.E. (2021). Validation of the 8th Edition American Joint Commission on Cancer (AJCC) Gallbladder Cancer Staging System: Prognostic Discrimination and Identification of Key Predictive Factors. Cancers, 13.","DOI":"10.3390\/cancers13030547"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1007\/s11605-007-0115-1","article-title":"Surgical management of gallbladder carcinoma: A review","volume":"11","author":"Mekeel","year":"2007","journal-title":"J. Gastrointest. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s11605-006-0075-x","article-title":"Diagnosis and surgical management of gallbladder cancer: A review","volume":"11","author":"Reid","year":"2007","journal-title":"J. Gastrointest. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4085","DOI":"10.3748\/wjg.v20.i14.4085","article-title":"Combined detection tumor markers for diagnosis and prognosis of gallbladder cancer","volume":"20","author":"Wang","year":"2014","journal-title":"World J. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1093\/gastro\/gou072","article-title":"Biliary strictures: Diagnostic considerations and approach","volume":"3","author":"Singh","year":"2015","journal-title":"Gastroenterol. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1111\/den.13360","article-title":"Case of successful endoscopic ultrasonography-guided gastrojejunostomy for gastric outlet obstruction caused by gallbladder carcinoma","volume":"31","author":"Tsuchiya","year":"2019","journal-title":"Dig. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s12664-019-01003-z","article-title":"Endoscopic ultrasound-guided celiac plexus neurolysis improves pain in gallbladder cancer","volume":"39","author":"Rai","year":"2020","journal-title":"Indian J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1002\/ijc.25421","article-title":"Gallbladder cancer: Incidence and survival in a high-risk area of Chile","volume":"127","author":"Bertran","year":"2010","journal-title":"Int. J. Cancer."},{"key":"ref_15","first-page":"415","article-title":"Primary carcinoma of the gallbladder: Operative experience during a 16 year period","volume":"159","author":"Oertli","year":"1993","journal-title":"Eur. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1245\/ASO.2004.03.011","article-title":"Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer","volume":"11","author":"Hawkins","year":"2004","journal-title":"Ann. Surg. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1007\/s11605-017-3440-z","article-title":"Gallbladder Cancer Presenting with Jaundice: Uniformly Fatal or Still Potentially Curable?","volume":"21","author":"Tran","year":"2017","journal-title":"J. Gastrointest. Surg."},{"key":"ref_18","first-page":"404","article-title":"Cholangitis: Diagnosis, Treatment and Prognosis","volume":"5","year":"2017","journal-title":"J. Clin. Transl. Hepatol."},{"key":"ref_19","first-page":"12","article-title":"Plastic versus metal stents for inoperable gallbladder cancer with hilar biliary obstruction: The jury is still out","volume":"34","author":"Jha","year":"2021","journal-title":"Ann. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Subramani, V.N., Avudaiappan, M., Yadav, T.D., Kumar, H., Sharma, V., Mandavdhare, H., Gorsi, U., and Singh, H. (2021). Outcome Following Percutaneous Transhepatic Biliary Drainage (PTBD) in Carcinoma Gallbladder: A Prospective Observational Study. J. Gastrointest. Cancer.","DOI":"10.21203\/rs.3.rs-171582\/v1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1001\/jamaoncol.2015.3670","article-title":"Comparison of Adverse Events for Endoscopic vs Percutaneous Biliary Drainage in the Treatment of Malignant Biliary Tract Obstruction in an Inpatient National Cohort","volume":"2","author":"Inamdar","year":"2016","journal-title":"JAMA Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.hpb.2016.03.002","article-title":"Percutaneous vs. endoscopic pre-operative biliary drainage in hilar cholangiocarcinoma\u2014A systematic review and meta-analysis","volume":"18","author":"Hameed","year":"2016","journal-title":"HPB"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.jvir.2016.12.1218","article-title":"Preoperative Biliary Drainage in Patients with Resectable Perihilar Cholangiocarcinoma: Is Percutaneous Transhepatic Biliary Drainage Safer and More Effective than Endoscopic Biliary Drainage? A Meta-Analysis","volume":"28","author":"Menahem","year":"2017","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s00534-012-0569-8","article-title":"TG13 indications and techniques for biliary drainage in acute cholangitis (with videos)","volume":"20","author":"Itoi","year":"2013","journal-title":"J. Hepatobiliary Pancreat. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e5253","DOI":"10.1097\/MD.0000000000005253","article-title":"The safety and efficacy of nasobiliary drainage versus biliary stenting in malignant biliary obstruction: A systematic review and meta-analysis","volume":"95","author":"Lin","year":"2016","journal-title":"Medicine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1097\/SLA.0b013e318262b2e9","article-title":"Preoperative endoscopic nasobiliary drainage in 164 consecutive patients with suspected perihilar cholangiocarcinoma: A retrospective study of efficacy and risk factors related to complications","volume":"257","author":"Kawashima","year":"2013","journal-title":"Ann. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"ASGE Technology Assessment Committee, Pfau, P.R., Pleskow, D.K., Banerjee, S., Barth, B.A., Bhat, Y.M., Desilets, D.J., Gottlieb, K.T., Maple, J.T., and Siddiqui, U.D. (2013). Pancreatic and biliary stents. Gastrointest Endosc., 77, 319\u2013327.","DOI":"10.1016\/j.gie.2012.09.026"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"139","DOI":"10.5946\/ce.2016.024","article-title":"Mechanisms of Biliary Plastic Stent Occlusion and Efforts at Prevention","volume":"49","author":"Kwon","year":"2016","journal-title":"Clin Endosc."},{"key":"ref_29","first-page":"654","article-title":"Wallstents versus plastic stents in malignant biliary obstruction: Effects of stent patency of the first and second stent on patient compliance and survival","volume":"91","author":"Schmassmann","year":"1996","journal-title":"Am. J. Gastroenterol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/j.gie.2015.03.1980","article-title":"Self-expandable metal stents versus plastic stents for malignant biliary obstruction: A meta-analysis","volume":"82","author":"Sawas","year":"2015","journal-title":"Gastrointest. Endosc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.clinre.2012.12.002","article-title":"Metal versus plastic stents for malignant biliary obstruction: An update meta-analysis","volume":"37","author":"Hong","year":"2013","journal-title":"Clin. Res. Hepatol. Gastroenterol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"E1218","DOI":"10.1055\/s-0043-120665","article-title":"Can we insert a covered stent, partially or not, in case of hilar biliary stenosis?","volume":"5","author":"Costamagna","year":"2017","journal-title":"Endosc. Int. Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E1211","DOI":"10.1055\/s-0043-117955","article-title":"Side-by-side partially covered self-expandable metal stent placement for malignant hilar biliary obstruction","volume":"5","author":"Kitamura","year":"2017","journal-title":"Endosc. Int. Open"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.gie.2016.03.1501","article-title":"Feasibility of the placement of a novel 6-mm diameter threaded fully covered self-expandable metal stent for malignant hilar biliary obstructions (with videos)","volume":"84","author":"Inoue","year":"2016","journal-title":"Gastrointest. Endosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"608","DOI":"10.5946\/ce.2020.189","article-title":"Stepwise Algorithmic Approach to Endoscopic Removal of Biliary Partially Covered and Uncovered Self-Expanding Metal Stents","volume":"54","author":"Jain","year":"2021","journal-title":"Clin. Endosc."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bo\u0161koski, I., Schepis, T., Tringali, A., Familiari, P., Bove, V., Attili, F., Landi, R., Perri, V., and Costamagna, G. (2021). Personalized Endoscopy in Complex Malignant Hilar Biliary Strictures. J. Pers. Med., 11.","DOI":"10.3390\/jpm11020078"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1111\/den.12700","article-title":"Metal versus plastic stents for unresectable gallbladder cancer with hilar duct obstruction","volume":"29","author":"Gao","year":"2017","journal-title":"Dig. Endosc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00534-012-0508-8","article-title":"Metallic stents are more efficacious than plastic stents in unresectable malignant hilar biliary strictures: A randomized controlled trial","volume":"20","author":"Mukai","year":"2013","journal-title":"J. Hepatobiliary Pancreat Sci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1055\/s-2001-17324","article-title":"Endoscopic ultrasound-guided bilioduodenal anastomosis: A new technique for biliary drainage","volume":"33","author":"Giovannini","year":"2001","journal-title":"Endoscopy"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1136\/flgastro-2016-100774","article-title":"Therapeutic endoscopic ultrasound","volume":"8","author":"Venkatachalapathy","year":"2017","journal-title":"Frontline Gastroenterol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s12328-014-0467-5","article-title":"Endoscopic ultrasound-guided biliary drainage: A review","volume":"7","author":"Iwashita","year":"2014","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s12328-021-01419-1","article-title":"The new era of endoscopic ultrasound in biliary disorders","volume":"14","author":"Lesmana","year":"2021","journal-title":"Clin. J. Gastroenterol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/den.13456","article-title":"Endoscopic ultrasound-guided versus endoscopic retrograde cholangiopancreatography-guided biliary drainage for primary treatment of distal malignant biliary obstruction: A systematic review and meta-analysis","volume":"32","author":"Jin","year":"2020","journal-title":"Dig. Endosc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"16551","DOI":"10.1038\/s41598-019-52993-x","article-title":"EUS-guided biliary drainage versus ERCP for first-line palliation of malignant distal biliary obstruction: A systematic review and meta-analysis","volume":"9","author":"Han","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"514","DOI":"10.4103\/IJPC.IJPC_94_19","article-title":"Symptom Palliation in Advanced GallBladder Cancer: An Institutional Experience","volume":"25","author":"Gupta","year":"2019","journal-title":"Indian J. Palliat. Care"},{"key":"ref_46","first-page":"1165","article-title":"Gallbladder carcinoma\u2014A rare cause of pyloric-duodenal stenosis","volume":"57","author":"Niculescu","year":"2016","journal-title":"Rom. J. Morphol. Embryol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/S0016-5107(04)02757-9","article-title":"Endoscopy or surgery for malignant GI outlet obstruction?","volume":"61","author":"Montino","year":"2005","journal-title":"Gastrointest. Endosc."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1007\/s004649900465","article-title":"Laparoscopic gastrojejunostomy and endoscopic biliary stent placement for palliation of incurable gastric outlet obstruction with cholestasis","volume":"11","author":"Brune","year":"1997","journal-title":"Surg. Endosc."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1055\/s-2004-814123","article-title":"Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies","volume":"36","author":"Maetani","year":"2004","journal-title":"Endoscopy"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1136\/gutjnl-2020-320775","article-title":"Endoscopic placement of covered versus uncovered self-expandable metal stents for palliation of malignant gastric outlet obstruction","volume":"70","author":"Yamao","year":"2021","journal-title":"Gut"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.tige.2020.03.011","article-title":"Endoscopic management of malignant gastric outlet obstruction","volume":"22","author":"Patel","year":"2020","journal-title":"Tech. Innov. Gastrointest. Endosc."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1016\/j.gie.2020.06.033","article-title":"Covered versus uncovered metal stents for malignant gastric outlet obstruction: A systematic review and meta-analysis","volume":"92","author":"Tringali","year":"2020","journal-title":"Gastrointest. Endosc."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"417","DOI":"10.5009\/gnl.2013.7.4.417","article-title":"Effects of the temporary placement of a self-expandable metallic stent in benign pyloric stenosis","volume":"7","author":"Choi","year":"2013","journal-title":"Gut Liver."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1111\/den.13186","article-title":"Adjusting the length and direction of the redundant duodenal stent using a detachable snare and endoclips","volume":"30","author":"Sasaki","year":"2018","journal-title":"Dig. Endosc."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1055\/s-2004-814434","article-title":"Self-expanding metal stents for gastroduodenal malignancies: Systematic review of their clinical effectiveness","volume":"36","author":"Dormann","year":"2004","journal-title":"Endoscopy"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"12468","DOI":"10.3748\/wjg.v21.i43.12468","article-title":"Self-expandable metal stents for malignant gastric outlet obstruction: A pooled analysis of prospective literature","volume":"21","author":"Rauws","year":"2015","journal-title":"World J. Gastroenterol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/1471-230X-7-18","article-title":"Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: A systematic review","volume":"7","author":"Jeurnink","year":"2007","journal-title":"BMC Gastroenterol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1016\/j.gie.2008.07.026","article-title":"Efficacy and safety of the new WallFlex enteral stent in palliative treatment of malignant gastric outlet obstruction (DUOFLEX study): A prospective multicenter study","volume":"69","author":"Uitdehaag","year":"2009","journal-title":"Gastrointest. Endosc."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e19432","DOI":"10.1097\/MD.0000000000019432","article-title":"Clinical outcomes after multiple self-expandable metallic stent placement using stent-in-stent technique for malignant gastric outlet obstruction","volume":"99","author":"Mo","year":"2020","journal-title":"Medicine"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1505","DOI":"10.1007\/s00464-010-1426-y","article-title":"Self-expandable metallic stent placement for malignant obstruction in patients with locally recurrent gastric cancer","volume":"25","author":"Kim","year":"2011","journal-title":"Surg. Endosc."},{"key":"ref_61","first-page":"535","article-title":"Current uses and outcomes of lumen-apposing metal stents","volume":"31","author":"Mussetto","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/eus.eus_70_19","article-title":"EUS-guided gastroenterostomy for the management of gastric outlet obstruction: A systematic review and meta-analysis","volume":"9","author":"Iqbal","year":"2020","journal-title":"Endosc. Ultrasound."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"E1474","DOI":"10.1055\/a-0996-8178","article-title":"Efficacy and safety of EUS-guided gastroenterostomy for benign and malignant gastric outlet obstruction: A systematic review and meta-analysis","volume":"7","author":"McCarty","year":"2019","journal-title":"Endosc. Int. Open"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1007\/s00423-021-02215-8","article-title":"EUS-guided gastroenterostomy versus duodenal stent placement and surgical gastrojejunostomy for the palliation of malignant gastric outlet obstruction: A systematic review and meta-analysis","volume":"406","author":"Boghossian","year":"2021","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1097\/MCG.0000000000000887","article-title":"EUS-guided Gastrojejunostomy Versus Laparoscopic Gastrojejunostomy: An International Collaborative Study","volume":"51","author":"Tyberg","year":"2017","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/S1479-666X(08)80073-X","article-title":"Gallbladder cancer--a comprehensive review","volume":"6","author":"Lai","year":"2008","journal-title":"Surgeon"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/j.1440-1746.2005.03576.x","article-title":"Gallbladder cancer in India: A dismal picture","volume":"20","author":"Batra","year":"2005","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.1016\/S1470-2045(12)70040-2","article-title":"Use of opioid analgesics in the treatment of cancer pain: Evidence-based recommendations from the EAPC","volume":"13","author":"Caraceni","year":"2012","journal-title":"Lancet Oncol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.36076\/ppj.2008\/11\/S105","article-title":"Opioid complications and side effects","volume":"11","author":"Benyamin","year":"2008","journal-title":"Pain Physician."},{"key":"ref_70","first-page":"77","article-title":"Interventional Management of Chronic Visceral Pain Syndromes","volume":"10","author":"Hamada","year":"2021","journal-title":"Anesth. Analg."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1002\/ca.20964","article-title":"A review of the thoracic splanchnic nerves and celiac ganglia","volume":"23","author":"Loukas","year":"2010","journal-title":"Clin. Anat."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"2330","DOI":"10.1007\/s10620-008-0651-x","article-title":"EUS-guided celiac plexus neurolysis for pain due to chronic pancreatitis or pancreatic cancer pain: A meta-analysis and systematic review","volume":"54","author":"Puli","year":"2009","journal-title":"Dig. Dis. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.gie.2018.08.005","article-title":"EUS-guided celiac ganglion radiofrequency ablation versus celiac plexus neurolysis for palliation of pain in pancreatic cancer: A randomized controlled trial (with videos)","volume":"89","author":"Bang","year":"2019","journal-title":"Gastrointest. Endosc."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1097\/MCG.0b013e3181bb854d","article-title":"Efficacy of endoscopic ultrasound-guided celiac plexus block and celiac plexus neurolysis for managing abdominal pain associated with chronic pancreatitis and pancreatic cancer","volume":"44","author":"Kaufman","year":"2010","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"3541","DOI":"10.1200\/JCO.2010.32.2750","article-title":"Randomized, double-blind, controlled trial of early endoscopic ultrasound-guided celiac plexus neurolysis to prevent pain progression in patients with newly diagnosed, painful, inoperable pancreatic cancer","volume":"29","author":"Wyse","year":"2011","journal-title":"J. Clin. Oncol."},{"key":"ref_76","first-page":"238","article-title":"Palliative Endoscopic Treatment Options in Malignancies of the Biliopancreatic System","volume":"30","author":"Feisthammel","year":"2014","journal-title":"Viszeralmedizin"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1111\/den.13298","article-title":"Endoscopic radiofrequency biliary ablation treatment: A comprehensive review","volume":"31","author":"Larghi","year":"2019","journal-title":"Dig. Endosc."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.brachy.2018.03.006","article-title":"Technique for the administration of high-dose-rate brachytherapy to the bile duct using a nasobiliary catheter","volume":"17","author":"Deufel","year":"2018","journal-title":"Brachytherapy"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"E259","DOI":"10.1055\/s-0030-1255862","article-title":"Iodine-125 biliary stent for palliative treatment of locally advanced gallbladder cancer","volume":"42","author":"Guo","year":"2010","journal-title":"Endoscopy"},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Clavien, P.A., Awad, M.M., and Choti, M.A. (2007). Radiofrequency ablation of liver tumors. Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Springer.","DOI":"10.1007\/978-3-540-68866-2"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.gie.2010.09.031","article-title":"Endoscopically applied radiofrequency ablation appears to be safe in the treatment of malignant biliary obstruction","volume":"73","author":"Steel","year":"2011","journal-title":"Gastrointest. Endosc."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1454","DOI":"10.1111\/jgh.14657","article-title":"The safety of newly developed automatic temperature-controlled endobiliary radiofrequency ablation system for malignant biliary strictures: A prospective multicenter study","volume":"34","author":"Lee","year":"2019","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_83","first-page":"317","article-title":"The use of \u00b9\u00b2\u2075I seed strands for intraluminal brachytherapy of malignant obstructive jaundice","volume":"27","author":"Chen","year":"2012","journal-title":"Cancer Biother. Radiopharm."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1007\/s00270-017-1827-6","article-title":"A Systematic Review and Meta-analysis of Intraluminal Brachytherapy Versus Stent Alone in the Treatment of Malignant Obstructive Jaundice","volume":"41","author":"Xu","year":"2018","journal-title":"Cardiovasc. Intervent. Radiol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4251\/wjgo.v8.i3.240","article-title":"Endoscopic palliation of malignant biliary strictures","volume":"8","author":"Salgado","year":"2016","journal-title":"World J. Gastrointest. Oncol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/S0016-5107(03)70021-2","article-title":"Phase II study of photodynamic therapy and metal stent as palliative treatment for nonresectable hilar cholangiocarcinoma","volume":"57","author":"Dumoulin","year":"2003","journal-title":"Gastrointest. Endosc."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.pdpdt.2012.03.002","article-title":"Photodynamic therapy for unresectable cholangiocarcinoma: A comparative effectiveness systematic review and meta-analyses","volume":"9","author":"Leggett","year":"2012","journal-title":"Photodiagnosis Photodyn. Ther."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/7\/1686\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:43:47Z","timestamp":1760136227000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/7\/1686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,26]]},"references-count":87,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2022,4]]}},"alternative-id":["cancers14071686"],"URL":"https:\/\/doi.org\/10.3390\/cancers14071686","relation":{},"ISSN":["2072-6694"],"issn-type":[{"value":"2072-6694","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,26]]}}}