Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis

Background Pancreatic cancer (PC) often produces pain that is difficult to control. Celiac neurolysis (CN) is performed with the goal of improving pain control and quality of life while reducing opioid-related side effects. Objective We aimed to evaluate whether CN provides a survival advantage for PC patients. Design Retrospective case-control study. Setting Single tertiary-care referral center. Patients Review of a prospectively maintained database identified patients with unresectable PC who underwent CN over a 12-year period. Each patient was matched to 2 control patients with unresectable PC. Intervention CN, which included both celiac plexus neurolysis (CPN) and celiac ganglia neurolysis (CGN). Main Outcome Measurements Median survival in Kaplan-Meier curves and hazard ratios. Results A total of 417 patients underwent CN and were compared with 840 controls with PC. Baseline characteristics were similar except the CN group had greater weight loss and pain requiring opioids. A mean of 16.6 ± 5.8 mL of alcohol was administered. For patients who underwent CN, the median survival from the time of presentation was shorter compared with controls (193 vs 246 days; hazard ratio 1.32; 95% confidence interval, 1.13–1.54). There was no difference in survival with unilateral or bilateral injection. However, EUS-guided CN was associated with longer survival compared with non-EUS approaches, and those who received CPN had longer survival compared with CGN. Limitations Single center, retrospective. Conclusion Our study suggests that CN is an independent predictor of shortened survival in PC patients. A prospective study is needed to verify the findings and determine whether shortened survival results from CN or from other features such as performance status and tumor-related characteristics. It is also imperative to verify our finding that EUS-guided CN provides a survival advantage over other approaches and whether CPN prolongs survival compared with CGN.

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“…The patient with permanent paralysis underwent EUS-guided CGN and was previously presented as a case report. 18 …”

Section: Resultsmentioning

confidence: 99%

Impact of celiac neurolysis on survival in patients with pancreatic cancer

Fujii-Lau

Bamlet

Eldrige

et al. 2015

Gastrointestinal Endoscopy

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“…In 75% of people, the artery of Adamkiewicz originates on the left side of the aorta between the T8 and L1 vertebral segments 22. Although, this a relatively rare event, similar cases were reported after each of the techniques: the posterior percutaneous under image guidance,22,24 the anterior open technique under direct view25,26,27 and the anterior endoscopic guided technique 28…”

Section: Discussionmentioning

confidence: 89%

Celiac plexus neurolysis for the treatment of upper abdominal cancer pain

Teixeira¹,

Neto²,

Nóbrega³

et al. 2013

NDT

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Optimal treatment of oncologic pain is a challenge to all professionals who deal with cancer and its complications. The management of upper abdominal pain is usually difficult and it is often refractory to conservative therapies. In this context, celiac plexus neurolysis (CPN) appears to be an important and indispensable tool because it alleviates pain, gives comfort to patients and is a safe procedure. In this study, the importance of CPN is reviewed by a retrospective study of 74 patients with pain due to upper abdominal cancer. Almost all cases evaluated (94.6%) had an excellent result after CPN and the majority of side effects were transitory.

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“…The late side effects include diarrhea, hypotension, fever, and paraplegia [154]. Several severe side effects have been reported, e.g., permanent lower paraplegia due to spinal cord infarction [155,156], hepatic, splenic, and renal infarction [157], and lethal perforation of aorta and stomach [158].…”

Section: Pain Palliation By Eus-guided Celiac Plexus Neurolysismentioning

confidence: 99%

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

Seicean¹

2014

Pancreatic Cancer - Insights Into Molecular Mechanisms and Novel Approaches to Early Detection and Treatment

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Anterior spinal cord infarction with permanent paralysis following endoscopic ultrasound celiac plexus neurolysis

Cited by 53 publications

References 0 publications

Impact of celiac neurolysis on survival in patients with pancreatic cancer

Impact of celiac neurolysis on survival in patients with pancreatic cancer

Celiac plexus neurolysis for the treatment of upper abdominal cancer pain

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

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