Predictive Factors for Pain Relief After Endoscopic Ultrasound-Guided Celiac Plexus Neurolysis

Abstract

EUS-CPN seems to be less effective in patients with direct invasion of the celiac plexus. Ethanol should be injected on both sides of the celiac axis to obtain greater pain relief.

Predictors of pain response in patients undergoing endoscopic ultrasound-guided neurolysis for abdominal pain caused by pancreatic cancer

“…In another study by Iwata and colleagues, limited distribution of alcohol to the left side of the CA was a significant factor associated with a negative response to EUS-CPN [Iwata et al 2011]. In the present study, the response rates at 1 and 4 weeks correlated with the number of neurolytic/contrast spread areas.…”

Endoscopic Ultrasound in Pancreatic Cancer: The New Perspective

“…The predictors of pain alleviation were found to be lack of ganglia visualization [153], direct invasion of celiac ganglia, and leftward diffusion of the neurolytic agent [145]. The pain was also less severe, albeit not significantly so, for tumors located in the body or tail of the pancreas, for large tumors, and for patients with severe pain at presentation [153].…”

“…The post-neurolytic residual pain could be related to non-visceral pain owing to invasion of the muscles or surrounding connective tissue. The bilateral technique on both sides of the celiac trunk was associated with a rate of pain alleviation of 45-88% [142][143][144], while the central technique, with injection above the celiac trunk, showed 68-72% alleviation [145,146].…”

Pancreatic cancer pain: impact and management challenges

“…1,15,19 Puli et al, Lillemoe et al, and Iwata et al, all, found that bilateral CPN was associated with improved pain control compared with unilateral neurolysis. 1,16,19 This likely holds true despite specific approach. In a randomized controlled trial, Wong et al demonstrated decreased pain with quality of life improvement throughout the duration of the study period …”

“…15 Iwata et al found that, in those patients with favorable characteristics to successful outcomes, early intervention was preferable. 16 Wyse wrote in a randomized control trial of patients undergoing staging EUS early on in the course of their disease that "CPN is currently used late in the disease evolution as a salvage therapy for morphine-resistant pancreatic cancer pain. Because EUS is used at the beginning of the diagnostic algorithm for pancreatic cancer, it gives an opportunity to perform EUS-CPN early".…”