Original articleClinical endoscopyEUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video)
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.