1037 SUPERIORITY OF EUS-GUIDED RFA OVER EUS-GUIDED CPN FOR PALLIATION OF PAIN IN PANCREATIC CANCER IN A RANDOMIZED TRIAL

Abstract

Although frequently performed, the efficacy of celiac plexus neurolysis (EUS-CPN) for palliation of pain in pancreatic cancer is suboptimal. Recently, EUS-guided radiofrequency ablation (EUS-RFA) has been proposed as a palliative treatment modality for pancreatic neoplasms. We performed a single-blind, randomized trial to compare the effectiveness of EUS-CPN and EUS-RFA for palliation of pain in pancreatic cancer. Patients with abdominal pain due to locally advanced or metastatic pancreatic cancer underwent EUS-CPN (n=14) or EUS-RFA (n=12). EUS-RFA was performed using a 1mm monopolar (Habib EndoHPB) probe passed via a 19G FNA needle and by targeting the area of celiac plexus or visualized ganglia. The primary endpoint was quality of life (QOL) as measured by the European Organization for Research and Treatment of Cancer (EORTC) core cancer (QLQ-C30) and pancreatic cancer-specific (QLQ-PAN26) questionnaires that were administered pre-treatment and at 2 and 4-weeks post-treatment. The core cancer (QLQ-C30) assessment revealed less pain (51.9 vs. 64.4, P=0.032) for EUS-RFA over EUS-CPN cohort. Likewise, when compared to EUS-CPN, the pancreatic cancer specific (QLQ-PAN26) questionnaire revealed less pain (49 vs. 57, P<0.001), fewer digestive symptoms (39.1 vs. 53.5, P=0.031), less alteration in bowel habits (16.9 vs. 24.8, P=0.029), less indigestion (20.6 vs. 51, P<0.001), less fear of future health (56.8 vs. 69.3, P=0.001) and better ability to plan for future (50.1 vs. 68.5, P=0.003) for the EUS-RFA cohort. Compared to EUS-CPN, EUS-guided RFA provided more pain relief and improved quality of life.