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. 2013 Jul;2(3):153-6.
doi: 10.7178/eus.06.007.

Central is as effective as bilateral endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer

Felix I Téllez-Ávila  1 , Adriana Fabiola Romano-Munive  2 , Jose de Jesús Herrera-Esquivel  1 , Miguel Angel Ramírez-Luna  1
Affiliations

Central is as effective as bilateral endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer

Felix I Téllez-Ávila et al. Endosc Ultrasound. 2013 Jul.

Abstract

Objective: The objective of this study is to compare the efficacy of central (single) vs bilateral (2-injections) endoscopic ultrasound (EUS)-celiac plexus neurolysis (CPN) for palliation of patients with pain related to pancreatic cancer.

Materials and methods: Patients with unresectable pancreatic cancer were included. Central EUS CPN was used in the first group and bilateral EUS CPN in the second. The measurement of pain was made with a visual analog pain scale (VAPS) applied before and after the procedure. Follow-up was made at weeks 2 and 4 after the procedure. The use of morphine before and after EUS CPN was evaluated. Complications related to the procedure were recorded.

Results: A total of 53 patients underwent EUS CPN, 21 (39.6%) with the central technique and 32 (60.4%) with bilateral injection; 29 were women (54.7%) and the median age was 59 (30-85) years. The tumor was located in the head of the pancreas in 24 (45.3%) patients, the neck in 14 (26.4%), the body in 26 (49.1%) and in the tail of the pancreas in 8 (15.1%). Nearly, 14 (26.4%) patients had more than one pancreatic segment involved. There was no difference in the median (range) percent pain reduction from baseline-4 weeks later was 50% (0-100) vs 60% (0-100), for central and bilateral techniques, respectively; P = 0.18. In total, 60.4% of patients had a reduction of 50% punctuation in the VAPS. No major complications were detected.

Conclusions: EUS CPN is useful for the management of pain in patients with unresectable pancreatic cancer, but there is no significant difference between central vs bilateral techniques.

Keywords: Celiac plexus; endoscopic ultrasound; neurolysis.

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Figures

Figure 1
Figure 1
Percent pain reduction from baseline-2 weeks later (A) and baseline-4 weeks (B) after classification by central vs bilateral technique
See this image and copyright information in PMC

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