EUS-Guided Versus Percutaneous Celiac Neurolysis for the Management of Intractable Pain Due to Unresectable Pancreatic Cancer: A Randomized Clinical Trial

Abstract

Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.

EUS-guided celiac plexus neurolysis for pain in pancreatic cancer patients – a meta-analysis and systematic review

“…An initial search identified 176 articles, out of which 142 studies were initially excluded (studies that involved chronic pancreatitis patients and studies presented as abstracts in conferences). Thirty-four relevant studies were selected and reviewed in detail, of which 18 studies that utilized celiac plexus block technique were excluded and only 16 studies met the final inclusion criteria [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. Figure 1 shows the search results.…”

Factors associated with successful response to neurolytic celiac plexus block in patients with upper abdominal cancer-related pain: a retrospective study

“…Several studies have demonstrated the benefit of NCPB by comparing it with standard systemic medical therapy; NCPB can provide analgesia more effectively and lead to a reduction in the use of opioids and their related side effects [ 8 , 11 , 17 , 23 - 26 ]. Wong et al [ 8 ] demonstrated that NCPB could provide more effective analgesia than a sham block and systemic therapy.…”

“…For the transdiscal approach, a virtual transdiscal needle pathway was drawn and the oblique angle from the axis was measured in advance, using the most recent abdominal computed tomographic (CT) image before the procedure [ 17 , 18 ]. After positioning the needle obliquely to an angle measured from the anteroposterior view under fluoroscopic guidance, local skin infiltration was performed with 2% lidocaine.…”

Minimally-invasive pain management techniques in palliative care

“…The percutaneous group showed a slightly favorable reduction in back pain as compared to the endoscopic USG group but no reduction in opioid consumption was seen in either group. The results demonstrated that both techniques are safe, effective and should be utilized according to the expertise and resources available at each facility (24). Neurolytic celiac plexus block has been found to be very effective in pain control in pancreatic cancer patients especially if performed early in the course of the disease.…”