Schepis Tommaso, Boškoski Ivo, Tringali Andrea, Bove Vincenzo, Costamagna Guido
Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo A. Gemelli, 00168 Rome, Italy.
Centre for Endoscopic Research, Therapeutics and Training (CERTT), Università Cattolica del Sacro Cuore di Roma, Largo F. Vito, 00168 Rome, Italy.
Cancers (Basel). 2022 Mar 26;14(7):1686. doi: 10.3390/cancers14071686.
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' 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.
胆囊癌是一种罕见的恶性肿瘤，预后较差，由于就诊晚、周围组织早期浸润以及缺乏有效的治疗方法，其估计5年生存率为5%至13%。唯一的治愈方法是手术；然而，超过50%的病例在诊断时无法切除。在内镜检查与手术和化疗一起，是晚期胆囊癌无法进行根治性治疗时可用的姑息治疗选择。胆管炎、黄疸、胃出口梗阻和疼痛是晚期胆囊癌的常见并发症，可能需要内镜治疗以提高总体生存率和患者生活质量。内镜下胆道引流常用于治疗胆管炎和黄疸。内镜逆行胰胆管造影（ERCP）通常是首选技术，可根据具体临床情况放置塑料支架或自膨式金属支架。内镜超声引导下胆道引流是不适用于ERCP引流（如解剖结构改变）患者的一种替代方法。胃出口梗阻是胆囊恶性肿瘤与十二指肠壁接触并导致其受压生长的另一种罕见并发症。内镜检查是一种侵入性较小的手术替代方法，提供不同的选择，如腔内自膨式金属支架或内镜超声引导下胃肠吻合术。与癌症进展相关的腹痛通常采用药物治疗；然而，对于难以控制的疼痛，内镜超声引导下腹腔神经丛阻滞已被描述为一种有效且安全的治疗方法。局部治疗，如射频消融（RFA）、光动力疗法（PDT）和腔内近距离放射治疗（IBT），已被描述用于控制疾病进展；然而，它们在日常临床实践中的作用尚未确立。本研究的目的是对文献进行综述，以评估内镜检查和现有技术在晚期胆囊恶性肿瘤姑息治疗中的作用。
