Endoscopic ultrasound-guided celiac plexus neurolysis improves pain in gallbladder cancer.

Abstract

In gallbladder cancer (GBC), nearly 80% of patients present with pain in the upper abdomen. Narcotic analgesics are usually effective in relieving cancer pain, but induce adverse effects. Celiac plexus neurolysis (CPN) is an effective alternative to reduce pain caused by upper abdominal cancer; however, no published data is available on endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for pain relief in GBC. Patient with unresectable GBC with upper abdominal pain of severity ≥ 3 on visual analogue scale (VAS), not responding to non-steroidal anti-inflammatory drugs (NSAIDs) and tramadol were recruited prospectively over a 2-year period. EUS-CPN was done using the central approach in all thepatients. Pain severity was assessed using a VAS, prior to EUS-CPN and at 2, 4, and 8weeks after CPN. The technical success was achieved in 19 of 21 patients in whom the procedure was attempted. There was a significant improvement in pain severity as measured by VAS compared with the baseline at 2 and 4weeks aftertreatment (p < .001); at 8weeks, pain severity was less but was not statistically significant. At week 2, nearly 95% of patients had either complete or partial relief of pain. This response declined to 63% and 61% at 4 and 8weeks, respectively. There was a significant reduction in daily requirement of analgesics in all thepatients at 2 and 4weeks compared with baseline (p < .001); at week 8, there was no significant reduction in analgesic dose. EUS-CPN has a high technically success in mostpatients with GBC. It improved pain in about 60% to70% patients and lowered daily analgesic dose requirement for up to 4weeks. There was no procedure-related complication.