Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone

Levy, Michael J.; Gleeson, Ferga C.; Topazian, Mark D.; Fujii-Lau, Larissa L.; Enders, Felicity; Larson, Joseph J.; Mara, Kristin C.; Dayyeh, Barham K. Abu; Alberts, Steven R.; Hallemeier, Christopher L.; Iyer, Prasad G.; Kendrick, Michael L.; Mauck, William D.; Pearson, Randall K.; Petersen, Bret T.; Rajan, Elizabeth; Takahashi, Naoki; Vege, Santhi Swaroop; Wang, Kenneth K.; Chari, Suresh T.

doi:10.1016/j.cgh.2018.08.040

Cited by 49 publications

(56 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In another study done by Tak et al in 2017, CPN did not affect survival of patients with unresectable pancreatic malignancy, but it was a retrospective study. In a further study done by Levy et al 17 in 2018, they found CGN to shorten survival with no differences in quality of life as compared with CPN. Hence, they recommended reassessment of role of CGN in pain management for unresectable pancreatic cancer.…”

Section: Impact Of Eus Cpb or Cgn On Survival In Pancreatic Cancermentioning

confidence: 94%

See 1 more Smart Citation

EUS-Guided Celiac Plexus Interventions

Sharma

Bansal

Puri

2020

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

Endoscopic ultrasound (EUS)-guided celiac plexus intervention comprises EUS-guided celiac plexus block (EUS-CPB) and EUS-guided celiac plexus neurolysis (EUS-CPN). EUS-CPB and EUS-CPN are one of the used methods of pain management in patients of pancreatic cancer and chronic pancreatitis, respectively, along with medical therapy. Both the procedures are associated with minimal complications and improves quality of life. The role of EUS-guided celiac plexus intervention is increasing in gall bladder carcinoma for pain control.

show abstract

Section: Impact Of Eus Cpb or Cgn On Survival In Pancreatic Cancermentioning

confidence: 94%

“…Identification of celiac ganglion was associated with better results as compared with bilateral CPN. Another study was done by Levy et al 17 in 2018, which was a randomized trial comparing combined celiac ganglia and plexus neurolysis versus plexus neurolysis alone. This was done in 60 and 50 patients, respectively, in both the groups.…”

Section: Cgn Versus Cpnmentioning

confidence: 99%

EUS-Guided Celiac Plexus Interventions

Sharma

Bansal

Puri

2020

Journal of Digestive Endoscopy

View full text Add to dashboard Cite

show abstract

“…Later, the same researchers conducted an RCT to compare the effects of combined EUS-CGN and EUS-CPN to those of CPN alone regarding pain, QOL, and survival. 18 They found that CGN reduced the median survival time (5.59 months vs 10.46 months) without improving pain, QOL, or adverse events, compared to CPN. They suggested that injecting a caustic agent within the celiac ganglia might induce local or systemic immune, inflammatory, or metabolic pathways that enhanced tumor growth and spread, thereby promoting tumorassociated death.…”

Section: Impact On Survivalmentioning

confidence: 97%

“…The response rates at 12 weeks were 40.4% vs 46.2% for EUS-CPN and EUS-CGN, respectively (P = 0.84). 18 Recently, Kappelle et al 19 compared the spread of ethanol after various EUS-CGN and EUS-CPN procedures in human cadavers. EUS-CGN was performed with 1 mL of ethanol per ganglion using a 25-gauge needle (Technique 1) or a 22-gauge needle (Tech- nique 2) for all two visualized ganglia; 1 mL of ethanol was used for the largest ganglion using a 25-gauge needle (Technique 3) or with 4 mL ethanol per ganglion using 22-gauge needle (Technique 4).…”

Section: Efficacy and Prognostic Factors Following Treatmentmentioning

confidence: 99%

Recent topics on endoscopic ultrasonography-guided celiac plexus neurolysis

Yasuda

Hanaoka

Takahashi

et al. 2020

Int J Gastrointest Interv

View full text Add to dashboard Cite

Endoscopic ultrasonography-guided celiac plexus neurolysis (EUS-CPN) is a widely practiced technique. Three sets of guidelines have recently been published and this procedure has become a major EUS technique. However, there are still several unanswered questions. The purpose of this manuscript is to review the recent literature pertaining to EUS-CPN. Currently, the main indication of EUS-CPN is pancreatic cancer pain. It is also performed for patients with chronic pancreatitis, but the indication is controversial due to its limited efficacy and a high incidence of infectious complications. Various techniques, such as central and bilateral EUS-CPN, and EUS-guided direct celiac ganglia neurolysis (EUS-CGN) have been performed. However, the efficacies of these techniques remain controversial. Complications related to the procedures are generally not serious, but major adverse events, such as paraplegia and ischemic complications, have been reported. The impacts of EUS-CPN on survival have also been evaluated. Although increased survival was expected via improvements in the quality of life, data suggests that EUS-CPN related procedures, especially EUS-CGN, might reduce the survival time. However, precise mechanisms have not been elucidated. In addition to conventional techniques, new techniques, such as EUS-guided celiac ganglion radiofrequency ablation (EUS-RFA) and the use of highly viscous phenol-glycerol, dexmedetomidine, and contrast-enhanced agents, have been introduced. However, these techniques are still in experimental stages. Additional studies need to be conducted to address these gaps in the literature.

show abstract

“…The suboptimal efficacy of celiac plexus neurolysis might result from brief contact of the injectate with celiac ganglia. In a randomized controlled trial, Levy et al 29 compared the effects of endoscopic ultrasound-guided celiac ganglia neurolysis vs the effects of celiac plexus neurolysis on pain, quality of life, and survival. Celiac ganglia neurolysis reduced median survival time without improving pain, quality of life, or adverse events compared with celiac plexus neurolysis.…”

Section: Clinical Take Home Point 14mentioning

confidence: 99%

Covering the Year in CGH: 2019

Kanwal

2020

Clinical Gastroenterology and Hepatology

View full text Add to dashboard Cite

Combined Celiac Ganglia and Plexus Neurolysis Shortens Survival, Without Benefit, vs Plexus Neurolysis Alone

Cited by 49 publications

References 31 publications

EUS-Guided Celiac Plexus Interventions

EUS-Guided Celiac Plexus Interventions

Recent topics on endoscopic ultrasonography-guided celiac plexus neurolysis

Covering the Year in CGH: 2019

Contact Info

Product

Resources

About