The purpose of this study was to assess outcomes in patients who have undergone celiac plexus neurolysis (CPN) as treatment for refractory abdominal visceral pain at a tertiary care medical center. This study involved retrospective analysis of all patients who had undergone computed tomography (CT)-guided CPN over a 7-year period, as identified in the medical record. Cases were categorized into 1 of 3 groups-group 1: patients getting at least moderate improvement in pain but with improvements subsiding within 2 days; group 2: patients with some sustained pain relief but still requiring heavy doses of narcotics; group 3: patients with major or complete sustained reduction in pain where the narcotic dose was able to be reduced. One hundred thirty-eight cases were identified, 51 of which had no or insufficient follow-up, leaving 87 cases for analysis. Of the 87 cases, 31 (36%) were categorized as group 1, 21 (24%) as group 2, and 35 (40%) as group 3. There were no statistical differences in outcomes based on patient age, gender, time since diagnosis, or type of cancer. Documented postoperative complications were diarrhea (11 cases) and 1 case each of obtundation, hypotension, and presyncopal event. We conclude that patients undergoing CT-guided CPN for abdominal visceral pain achieve moderate or major short-term pain relief in a majority of cases. The procedure is safe with minimal complications.
Purpose: To evaluate the predictive value of portal vein pressures and porto-systemic gradients in patients prior to and following TIPS placement. Materials and Methods: Retrospective review of 100 patients that underwent TIPS at UCLA medical center between 2009 and 2013 was performed. Patients with documented pre-TIPS portal vein pressures as well as post-TIPS portal vein pressures and porto-systemic gradients were included. End points included survival to liver transplantation, one-year mortality, and need for revision. Results: Twenty-one patients that underwent TIPS went on to liver transplantation. For those patients, the mean pre-TIPS portal vein pressure (PVP) was 26.6 mmHg, pre-TIPS portosystemic gradient (PSG) 15.2, post-TIPS portal vein pressure 20.7, and post-TIPS portosystemic gradient 6.6.Twenty-seven patients that did not go onto liver transplantation were alive at one year. For those patients, the mean pre-TIPS PVP was 27.4, pre-TIPS PSG 18.1, post-TIPS PVP 21.2, and post-TIPS PSG 8.0.Twenty-one patients died within the first year. For those patients, the mean pre-TIPS PVP was 29.1, pre-TIPS PSG 18.2, post-TIPS PVP 22.1, post-TIPS PSG 7.1.Twenty-four patients required TIPS revision. For those patients, the mean pre-TIPS PVP was 29.1, pre-TIPS PSG 17.4, post-TIPS PVP 23.7, post TIPS PSG 8.2. Conclusion: Patients that were successfully bridged to transplantation with TIPS had the lowest pre-TIPS portal vein pressures, pre-TIPS portosystemic gradients, and post-TIPS portosystemic gradients. Patients that were dead at one year and requiring TIPS revision had higher pre-TIPS portal vein pressures. Thus in conclusion, portal vein pressure measurements and portosystemic gradients are helpful surrogates in predicting transplant and mortality outcomes following TIPS.
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