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. 2010 Feb 14;16(6):728-31.
doi: 10.3748/wjg.v16.i6.728.

Endoscopic ultrasound-guided celiac plexus neurolysis using a reverse phase polymer

Keith L Obstein  1 , Fernanda P Martins, Gloria Fernández-Esparrach, Christopher C Thompson
Affiliations

Endoscopic ultrasound-guided celiac plexus neurolysis using a reverse phase polymer

Keith L Obstein et al. World J Gastroenterol. .

Abstract

Aim: To assess the feasibility of endoscopic ultrasound (EUS)-guided celiac plexus neurolysis (CPN) using a poloxamer.

Methods: In this prospective evaluation, six Yorkshire pigs underwent EUS-guided CPN. Three received an injection of 10 mL of 0.25% Lidocaine plus methylene blue (group 1) and three received an injection of 10 mL of 0.25% Lidocaine plus blue colored poloxamer (PS137-25) (group 2). Necropsy was performed immediately after the animals were sacrificed. The abdominal and pelvic cavities were examined for the presence of methylene blue and the blue colored poloxamer.

Results: EUS-guided CPN was successfully performed in all 6 pigs without immediate complication. Methylene blue was identified throughout the peritoneal and retroperitoneal cavity in group 1. The blue colored poloxamer was found in the retroperitoneal cavity immediately adjacent to the aorta, in the exact location of the celiac plexus in group 2.

Conclusion: EUS-guided CPN using a reverse phase polymer in a non-survival porcine model was technically feasible. The presence of a poloxamer gel at the site of the celiac plexus at necropsy indicates a precise delivery of the neurolytic agent.

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Figures

Figure 1
Figure 1
Temperature profile of LeGoo-Endo™ (PS137-25) that transits from liquid to gel at body temperature. The viscosity of LeGoo-Endo™ with Lidocaine is slightly higher than LeGoo-Endo™ at body temperature.
Figure 2
Figure 2
Illustration of endoscopic ultrasound (EUS)-guided celiac plexus neurolysis (CPN). Figure from Arcidiacono PG, Rossi M. Celiac Plexus Neurolysis. J Pancreas 2004; 5: 315-321.
Figure 3
Figure 3
EUS-guided injection of Lidocaine plus blue colored poloxamer PS 137-25. The outer margin of the hypoechoic poloxamer is visualized upon injection into the celiac plexus (arrows).
Figure 4
Figure 4
Group 1 (A) and group 2 (B) at necropsy.
See this image and copyright information in PMC

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