Elsevier

Gastrointestinal Endoscopy

Volume 73, Issue 2, February 2011, Pages 267-274
Gastrointestinal Endoscopy

Original article
Clinical endoscopy
EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video)

https://doi.org/10.1016/j.gie.2010.10.029Get rights and content

Background

EUS-guided celiac plexus neurolysis (EUS-CPN) improves pain control in patients with pancreatic cancer. EUS allows visualization of the celiac ganglion.

Objective

To determine predictors of response to EUS-CPN in a cohort of 64 patients with pancreatic malignancy.

Design

Retrospective analysis of prospective database.

Setting

Academic medical center.

Patients

Sixty-four patients with pancreatic cancer referred for EUS between March 2008 and January 2010.

Interventions

EUS-CPN injected directly into celiac ganglia when visible by linear EUS or bilateral injection at the celiac vascular trunk.

Main Outcome Measurements

Predictors of pain improvement at week 1 by univariate and multivariate analysis.

Results

At week 1, 32 patients (50%) had a symptomatic response. In a multivariate model with 8 potential predictors, visualization of the ganglia was the best predictor of response; patients with visible ganglia were >15 times more likely to respond (odds ratio 15.7; P < .001). Tumors located outside the head of the pancreas and patients with a higher baseline pain level were weakly associated with a good response.

Limitations

Retrospective design and lack of blinding.

Conclusions

Visualization of celiac ganglia with direct injection is the best predictor of response to EUS-CPN in patients with pancreatic malignancy.

Section snippets

Materials and methods

This study is a result of a retrospective analysis of a prospectively collected database of patients undergoing EUS for pancreatic masses and CPN. Collection of data for pancreatic masses was started in January 2004, and analysis of celiac plexus neurolysis began in January 2008.

All patients >18 years of age referred to our center for EUS for (1) EUS-CPN in patients with confirmed pancreatic malignancy and (2) evaluation of a pancreatic mass who also complained of pain were included in the

Statistical analyses

Patient demographics and treatment characteristics, such as age, gender, tumor size and location, pain intensity, and narcotic use at presentation, were summarized as counts and percentages or mean, standard deviation, median, and range. Baseline and 1-week pain scores were compared by the paired Student t test. Chi-square test or Fisher exact test were used to compare therapy response rates at 1 week by potential predictors. These potential predictors included visualization of the ganglia,

Results

A total of 68 patients were enrolled in the study between March 2008 and January 2010. Four patients could not be contacted within a week for follow-up and were excluded from the final analysis. Patient demographics, disease, and treatment characteristics are reported in Table 1 for the 64 subjects with available data for analysis. Fifty-three patients were referred for initial evaluation of suspected pancreatic cancer and underwent EUS-FNA and EUS-CPN of the mass during the same procedure. The

Discussion

In this study, visualization of the celiac ganglia with direct injection into the ganglia was the best predictor of pain improvement after EUS-CPN. The overall response of 50% to EUS-CPN in our cohort is indicative of a moderate treatment efficacy; however, the response in patients with visible ganglia was much higher. A prospective randomized study comparing percutaneous celiac block combined with oral analgesia versus oral analgesia and a sham block demonstrated a moderate benefit of celiac

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DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

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