Laparoscopic versus open approach to neurolytic celiac plexus block in inoperable pancreatic cancer

Tepelenis, Kostas; Tsimogiannis, Konstantinos E; Zikos, Nikolaos; Koulas, Spyridon; Pappas-Gogos, George; Benetatos, Nikolaos; Tsimogiannis, Ioannis; Tsimoyiannis, Evangelos C.

doi:10.1111/ans.14560

Cited by 7 publications

(2 citation statements)

References 34 publications

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“…With the second type of CPN, I-CPN, the surgeon directly injects alcohol into the celiac plexus, and both open and laparoscopic approaches can be chosen. 5 The third type, EUS-CPN, is relatively new and allows for direct visualization of the origin of the celiac artery from the lesser curve of the stomach, so the injection distance is obviously shorter than in P-CPN. 6 In addition, Doppler assessment of the interposing vessels makes EUS-CPN safer and more accurate.…”

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confidence: 99%

Systematic review and meta‐analysis of celiac plexus neurolysis for abdominal pain associated with unresectable pancreatic cancer

et al. 2022

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Approximately 80% of patients with pancreatic cancer suffer from abdominal pain, and half of them require strong opioid analgesics. 1 However, in many cases, abdominal pain is not well-controlled with opioid analgesics alone, and these drugs must often be discontinued due to side effects such as constipation, nausea, and confusion. In such cases, alternative treatments are needed.Celiac plexus neurolysis (CPN) is an established therapy for the management of abdominal pain associated with unresectable pancreatic cancer. Its efficacy is based on the hypothesis that the celiac plexus relays pain signals from upper abdominal organs to the central nervous system. 2 Since its first introduction in 1919, 2 many different approaches have been proposed, and they can be roughly classified into three types: percutaneous CPN (P-CPN), intraoperative CPN (I-CPN), and endoscopic ultrasound-guided CPN (EUS-CPN

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confidence: 99%

Systematic review and meta‐analysis of celiac plexus neurolysis for abdominal pain associated with unresectable pancreatic cancer

et al. 2022

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“…Since its first introduction in 1919, 1 many different approaches to CPN have been proposed, and they can be roughly classified into the following three types: percutaneous CPN (P-CPN), intraoperative CPN (I-CPN), and endoscopic ultrasound-guided CPN (EUS-CPN). In P-CPN, the operator injects alcohol into the celiac plexus from the body surface, 2,3 while the open or laparoscopic approaches of I-CPN 4 involve direct injection into the celiac plexus. In EUS-CPN, the endoscopist visualizes the origin of the celiac artery by endoscopic ultrasonography and performs the injection from the lesser curve of the stomach.…”

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confidence: 99%

Efficacy of Endoscopic Ultrasound-guided Celiac Plexus Neurolysis for Abdominal Pain in Patients With Unresectable Pancreatic Cancer

Okita

Otani

Matsui

2022

Journal of Clinical Gastroenterology

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Goals: We conducted a systematic review and network meta-analysis to investigate the effect of endoscopic ultrasound-guided celiac plexus neurolysis added to medical management (EUS-CPN+MM) compared with MM, percutaneous CPN (P-CPN)+MM, or intraoperative CPN (I-CPN)+MM for abdominal pain associated with unresectable pancreatic cancer. Background: Many approaches to CPN have been proposed since 1919. EUS-CPN, which is less invasive and safer than traditional procedures, has been preferred recently, but the superiority of EUS-CPN+MM has not been fully investigated. Study: We performed searches of PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for randomized controlled trials (RCTs) on March 16, 2021. We conducted the network meta-analysis using a frequentist weighted least-squares approach. We used a random-effects model to synthesize the primary outcome, defined as the mean difference between treatment groups in standardized pain intensity scores at 4 and 12 weeks. Results: We selected 10 RCTs involving 662 individuals. At 4 weeks, the estimated mean difference between the EUS-CPN+MM and MM groups was −1.30 (95% CI: −2.19 to −0.41) in favor of EUS-CPN+MM, and that between the EUS-CPN+MM and P-CPN+MM groups was −0.88 (95% CI: −1.82 to 0.06). At 12 weeks, the estimated mean difference between the EUS-CPN+MM and MM groups was −2.58 (95% CI: −3.68 to −1.48), and that between the EUS-CPN+MM and P-CPN+MM groups was −2.44 (95% CI: −4.03 to −0.84), both in favor of EUS-CPN+MM. Conclusions: The combination of EUS-CPN+MM was effective at 4 and 12 weeks, although the risk of bias in synthesized studies was generally high, necessitating careful interpretation.

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Surgical Treatment of Pain in Chronic Pancreatitis

Loveday

Windsor

2021

Clinical Pancreatology for Practising Gastroenterologists and Surgeons

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Laparoscopic versus open approach to neurolytic celiac plexus block in inoperable pancreatic cancer

Abstract: The NCPB is feasible method for palliation in inoperable pancreatic cancer. Laparoscopic NCPB gives excellent results and could still be considered in selected cases, as an effective alternative during staging laparoscopy.

Cited by 7 publications

References 34 publications

Systematic review and meta‐analysis of celiac plexus neurolysis for abdominal pain associated with unresectable pancreatic cancer

Systematic review and meta‐analysis of celiac plexus neurolysis for abdominal pain associated with unresectable pancreatic cancer

Efficacy of Endoscopic Ultrasound-guided Celiac Plexus Neurolysis for Abdominal Pain in Patients With Unresectable Pancreatic Cancer

Surgical Treatment of Pain in Chronic Pancreatitis

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