Endoscopic Ultrasound-Guided Management of Pain in Chronic Pancreatitis and Pancreatic Cancer: an Update

Wyse, Jonathan; Sahai, Anand V.

doi:10.1007/s11938-018-0193-z

Cited by 13 publications

(4 citation statements)

References 34 publications

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“…5) have been widely practiced as a pain management procedure, mainly in palliative pancreatic cancer patients. The initial euphoric use has drifted to a more cautious, realistic and less frequent use of these techniques [79]. EUS-guided and percutaneous coeliac plexus neurolysis are equally effective in pancreatic cancer pain relief without significant differences in the rate of adverse events [80].…”

Section: Endoscopic Ultrasound-guided Coeliac Plexus Block and Coelia...mentioning

confidence: 99%

“…EUS-guided and percutaneous coeliac plexus neurolysis are equally effective in pancreatic cancer pain relief without significant differences in the rate of adverse events [80]. The effectiveness of EUS-CPB is much lower and the rate of side effects are worse in patients with chronic pancreatitis compared with EUS- CPN in pancreatic cancer patients [79]. Ischemic complications, abscess formation and other severe complications have been reported [81].…”

Section: Endoscopic Ultrasound-guided Coeliac Plexus Block and Coelia...mentioning

confidence: 99%

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Interventional endoscopic ultrasound

Dietrich

Braden

Jenssen

2021

Current Opinion in Gastroenterology

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Purpose of review To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques. Recent findings The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreatic duct, treatment of gastrointestinal haemorrhage, coeliac plexus block and coeliac plexus neurolysis, fiducial placement, solid and cystic tumour ablation, drug delivery and brachytherapy, gastroenterostomy, angiotherapy and other EUS-guided applications. The EUS-guided interventions are classified based on the available evidence as established or experimental, standardized or nonstandardized procedures in common or rare diseases with well or little known complications and their established or nonestablished treatment. Summary Some EUS-guided interventions have sparse published evidence with only single-centre studies, case series or individual case reports, others like drainage of peripancreatic fluid collections have become widely accepted practice. INVEUS has been accepted as an alternative to several surgical approaches, EUS-guided techniques result in faster recovery times, shorter hospital stay and lower costs.

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Section: Endoscopic Ultrasound-guided Coeliac Plexus Block and Coelia...mentioning

confidence: 99%

Section: Endoscopic Ultrasound-guided Coeliac Plexus Block and Coelia...mentioning

confidence: 99%

Interventional endoscopic ultrasound

Dietrich

Braden

Jenssen

2021

Current Opinion in Gastroenterology

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“…EUS- or CT-guided celiac plexus neurolysis is the interventional technique of choice for pain in PC and should be evaluated mainly in patients with severe pain requiring a high dose of potent narcotics. It is associated with pain relief in 54–88% of cases, improved quality of life and decreased opioid consumption [ 83 , 84 ] (quality of evidence: B; strength of recommendation: strong).…”

Section: Palliative Treatmentmentioning

confidence: 99%

Multidisciplinary consensus statement on the clinical management of patients with pancreatic cancer

et al. 2020

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Pancreatic cancer (PC) remains one of the most aggressive tumors with an increasing incidence rate and reduced survival. Although surgical resection is the only potentially curative treatment for PC, only 15–20% of patients are resectable at diagnosis. To select the most appropriate treatment and thus improve outcomes, the diagnostic and therapeutic strategy for each patient with PC should be discussed within a multidisciplinary expert team. Clinical decision-making should be evidence-based, considering the staging of the tumor, the performance status and preferences of the patient. The aim of this guideline is to provide practical and evidence-based recommendations for the management of PC.

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“…In order to overcome the limitations of systemic analgesic therapy, celiac plexus neurolysis (CPN) has been developed. [ 3 ] EUS-guided-CPN (EUS-CPN), consisting in the injection of a neurolytic agent directly into the celiac ganglion using a linear echoendoscope, was proven to be a relatively safe procedure able to significantly decrease the daily usage of narcotic analgesia and relieve pain in about 80% of treated patients. [ 4 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia represents a negative prognostic factor in pancreatic cancer patients undergoing EUS celiac plexus neurolysis

2020

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Background and Objectives: Increasing evidence suggests a prognostic role of sarcopenia in pancreatic cancer patients. The aim of this study was to assess the influence of sarcopenia on treatment outcomes after EUS-guided celiac plexus neurolysis (CPN). Materials and Methods: Data regarding 215 patients treated with EUS CPN between 2004 and 2019 were reviewed. Determination of body composition was conducted on contrast-enhanced CT scan, and pain response was considered as the primary outcome. Univariate and multivariate logistic regression was performed to identify the independent predictors of pain response. Results: Treatment was successful in 187 patients (86.9%). The median age was 62 (range 39–84) years, and most patients were male (61.8%). Of the whole study population, 139 patients (64.6%) were defined as sarcopenic, of which 116 (83.4%) responded to the treatment and 5 (3.5%) experienced a complete response. Among 76 nonsarcopenic participants, 71 (93.4%) responded to the treatment and 22 (28.9%) obtained a complete response ( P = 0.03 and <0.001, respectively). The median duration of pain relief was 8 (2–10) and 15 (8–16) weeks in sarcopenic and nonsarcopenic patients, respectively ( P = 0.01). The median overall survival after neurolysis was 4 months (3–5) in sarcopenic participants and 7 months (6–8) in nonsarcopenic participants ( P = 0.05). Tumoral stage, interval from the diagnosis to treatment, and sarcopenia resulted as significant prognostic factors for treatment response both in univariate and multivariate regression analyses. No severe treatment-related adverse events were reported in the whole study population, with no difference between the two groups. Conclusions: Sarcopenia represents a predictor of poorer response to EUS CPN.

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Endoscopic Ultrasound-Guided Management of Pain in Chronic Pancreatitis and Pancreatic Cancer: an Update

Cited by 13 publications

References 34 publications

Interventional endoscopic ultrasound

Interventional endoscopic ultrasound

Multidisciplinary consensus statement on the clinical management of patients with pancreatic cancer

Sarcopenia represents a negative prognostic factor in pancreatic cancer patients undergoing EUS celiac plexus neurolysis

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