Abstract
Although endoscopic ultrasound-guided celiac neurolysis (EUS-CN) and percutaneous celiac neurolysis (PCN) are utilized to manage intractable pain in pancreatic cancer patients, no direct comparison has been made between the two methods. We compared the efficacy and safety of EUS-CN and PCN in managing intractable pain in such patients. Sixty pancreatic cancer patients with intractable pain were randomly assigned to EUS-CN (n = 30) or PCN (n = 30). The primary outcomes were pain reduction in numerical rating scale (NRS) and opioid requirement reduction. Secondary outcomes were: successful pain response (NRS decrease ≥50% or ≥3-point reduction from baseline); quality of life; patient satisfaction; adverse events; and survival rate at 3 months postintervention. Both groups reported sustained decreases in pain scores up to 3 months postintervention (mean reductions in abdominal pain: 0.9 (95% confidence interval (CI): −0.8 to 4.2) and 1.7 (95% CI: −0.3 to 2.1); back pain: 1.3 (95% CI: −0.9 to 3.4) and 2.5 (95% CI: −0.2 to 5.2) in EUS-CN, and PCN groups, respectively). The differences in mean pain scores between the two groups at baseline and 3 months were −0.5 (p = 0.46) and −1.4 (p = 0.11) for abdominal pain and 0.1 (p = 0.85) and −0.9 (p = 0.31) for back pain in favor of PCN. No significant differences were noted in opioid requirement reduction and other outcomes. EUS-CN and PCN were similarly effective and safe in managing intractable pain in pancreatic cancer patients. Either methods may be used depending on the resources and expertise of each institution.
Highlights
Pancreatic cancer has an overall 5-year survival rate of about 6% and is one of the leading contributors of cancer-related deaths in the world [1]
Patients with pancreatic cancer who were deemed as non-surgical candidates and met the following criteria were considered for randomization: (1) diagnosis of pancreatic cancer based on clinical, radiological, or pathological assessment; (2) referred for abdominal and/or back pain due to pancreatic cancer; (3) between 20 and 80 years of age; (4) no prior celiac neurolysis (CN); (5) cancer pain unresponsive to the WHO 3-step analgesic ladder; and (6) willingness to consent for the participation in the trial
Another systematic review reported that percutaneous celiac neurolysis (PCN) was beneficial for pain management by reducing opioid consumption and associated side effects in patients with abdominal cancer [12]
Summary
Pancreatic cancer has an overall 5-year survival rate of about 6% and is one of the leading contributors of cancer-related deaths in the world [1]. EUS-CN is preferred over PCN in some institutions with expertise [16,17], as it confers better pain relief compared with systemic analgesic therapy [18] and potentially improved safety by using a transgastric approach, which allows direct access to the celiac plexus to reduce the risk of injuries to the spinal nerve, diaphragm, or spinal artery [5,14,19]. Both EUS-CN and PCN are widely used, the selection between the two methods has not been based on robust evidence, let alone a randomized, controlled study comparing EUS-CN and PCN for management of cancer pain. The two methods were compared in terms of reduction of pain and opioid requirement, QOL, patient satisfaction, adverse events (AEs), and survival rate at 3 months after intervention
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