Endoscopic ultrasound-guided celiac plexus neurolysis improves pain in gallbladder cancer

Abstract

Introduction: In gallbladder cancer (GBC), nearly 80% of patients present with pain in the upper abdomen. Narcotic analgesics are usually effective in relieving cancer pain, but induce adverse effects. Celiac plexus neurolysis (CPN) is an effective alternative to reduce pain caused by upper abdominal cancer; however, no published data is available on endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for pain relief in GBC.

Methods: Patient with unresectable GBC with upper abdominal pain of severity ≥ 3 on visual analogue scale (VAS), not responding to non-steroidal anti-inflammatory drugs (NSAIDs) and tramadol were recruited prospectively over a 2-year period. EUS-CPN was done using the central approach in all the patients. Pain severity was assessed using a VAS, prior to EUS-CPN and at 2, 4, and 8 weeks after CPN.

Results: The technical success was achieved in 19 of 21 patients in whom the procedure was attempted. There was a significant improvement in pain severity as measured by VAS compared with the baseline at 2 and 4 weeks after treatment (p < .001); at 8 weeks, pain severity was less but was not statistically significant. At week 2, nearly 95% of patients had either complete or partial relief of pain. This response declined to 63% and 61% at 4 and 8 weeks, respectively. There was a significant reduction in daily requirement of analgesics in all the patients at 2 and 4 weeks compared with baseline (p < .001); at week 8, there was no significant reduction in analgesic dose.

Conclusion: EUS-CPN has a high technically success in most patients with GBC. It improved pain in about 60% to 70% patients and lowered daily analgesic dose requirement for up to 4 weeks. There was no procedure-related complication.

Keywords: Celiac plexus neurolysis; Endoscopic ultrasound; Gallbladder cancer; Visual analogue scale.