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Role of Endoscopic Ultrasonography Guided Celiac Plexus Neurolysis in the Management of Pancreatic Cancer Pain

Author: Rayadh A. Z. Al-Sharifi
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 1 Pages: 79-84
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية


ABSTRACT:BACKGROUND:Celiac plexus neurolysis (CPN), a chemical splanchnicectomy of the celiac plexus, is used to treat pain caused by pancreatic cancer. Originally performed by anesthesiologists and radiologists via a posterior approach, recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus neurolysis (CPN) is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior percutaneous approach.OBJECTIVE:To assess the efficacy and safety of EUS guided celiac plexus neurolysis in the management of pain caused by pancreatic cancer.METHODS:This study included (310) patients with painful and inoperable pancreatic cancer were submitted to EUS guided celiac plexus neurolysis (CPN) at a tertiary referral center. The following data were collected: age, gender, tumor location, vascular invasion, adjuvant therapy, and laboratory tests including prothrombin time, and complete blood counts were obtained at baseline (before EUS celiac plexus neurolysis).RESULTS:Of 310 procedures performed, 217(70%) patients develop immediate and complete pain relieves (within 24 hours of procedure) and no need for narcotic analgesia during follows up (12 weeks). Sixty-one (20%) patients had partial response to the procedure (decreasing in the need for narcotic analgesia during follow up). Thirty-two (10%) patients were lost to follow up and no outcome of procedure obtained.CONCLUSION:EUS is more safe, feasible, and more effective than other methods in performing CPN and controls pain caused by unresectable pancreatic cancer.

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