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Abstract
The most common symptom in patients with advanced pancreatic cancer is abdominal pain. This has traditionally been treated with nonsteroidal anti-inflammatory drugs and opioid analgesics. However, these treatments result in inadequate pain control or drug-related adverse effects in some patients. An alternative pain-relief modality is celiac plexus neurolysis, in which the celiac plexus is chemically ablated. This procedure was performed percutaneously or intraoperatively until 1996, when endoscopic ultrasound (EUS)-guided celiac plexus neurolysis was first described. In this transgastric anterior approach, a neurolytic agent is injected around the celiac trunk under EUS guidance. The procedure gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated pain. We focus on two relatively new techniques of EUS-guided neurolysis: EUS-guided celiac ganglia neurolysis and EUS-guided broad plexus neurolysis, which have been developed to improve efficacy. Although the techniques are safe and effective in general, some serious adverse events including ischemic and infectious complications have been reported as the procedure has gained widespread popularity. We summarize reported clinical outcomes of EUS-guided neurolysis in pancreatic cancer (from the PubMed and Embase databases) with a goal of providing information useful in developing strategies for pancreatic cancer-associated pain alleviation.
Highlights
Pancreatic cancer has one of the worst prognoses among all solid carcinomas
These results indicate thatpain be superior to weeks drug-based management for pain relief control, endoscopic ultrasound (EUS)-celiac plexus neurolysis (CPN)
Paraplegia following EUS-guided neurolysis is thought to be caused by acute spinal cord ischemia resulting from injury to the anterior radicular artery or from vasospasm associated with neurolytic agent injection
Summary
Pancreatic cancer has one of the worst prognoses among all solid carcinomas. The 5-year overall survival in pancreatic cancer remains dismal, with approximately 5–10% of patients surviving; more than half of the patients do not survive beyond 1 year [1,2]. Some patients experience serious drug-related side effects that can markedly reduce quality of life Under such circumstances, celiac plexus neurolysis (CPN), in which the celiac plexus (CP) is chemically ablated, has been widely performed as an alternative treatment for alleviating cancer-associated pain [4,7]. In EUS-CPN, a neurolytic agent is injected around the celiac trunk using a linear-array echo endoscope Since the time it was first described, EUS-CPN has been widely applied as a minimally invasive approach in treating pancreatic cancer-associated pain. EUS-guided neurolysis is thought to be safer than the conventional percutaneous approach because EUS, with color Doppler technology, provides detailed real-time imaging of blood vessels around the gastric lumen As these EUS-guided techniques have gained widespread popularity, serious procedure-related adverse effects including ischemic and infectious complications have been reported [12,13]. The aim of this review is to summarize clinical outcomes of EUS-guided neurolysis in pancreatic cancer with a goal of providing information useful for development of strategies to alleviate pancreatic cancer-associated pain
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