Tu1517 A Prospective Controlled Study on the EUS-CPN Bilateral Injection of 30 CC of Alcohol in Patients With Pancreatic Cancer Pain

Abstract

A Prospective Controlled Study on the EUS-CPN Bilateral Injection of 30 CC of Alcohol in Patients With Pancreatic Cancer Pain Jose C. Ardengh*, Rafael Kemp, Eder R. Lima, Cristina G. Bertani, Gustavo A. Mota, Jose Sebastiao S. Dos Santos Anatomy and Surgery, Hosp. Clin. Fac. Med. Ribeirao Preto Universidade de Sao Paulo, Sao Paulo, Brazil; Endoscopy and Echoendoscopy, Hospital 9 de Julho, Sao Paulo, Brazil; Surgery, Hospital Federal dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, Brazil Introduction: Celiac plexus neurolysis (CPN) is currently used as a treatment option for morphine (resistant patients). The technique of alcohol injection during EUS-CPN for pancreatic cancer pain has not yet been standardized. The one or two injections, bilateral, or central techniques and drug combinations has been discussed. The aim of this study is to demonstrate the safety and efficacy of bilateral injection of absolute alcohol (30 cc) in patients with uncontrollable pain related to pancreatic cancer. Patients and methods: Patients who had a confirmed diagnosis and staging of unresectable pancreatic cancer, after surgery, EUS-FNA, US-FNA or CT-FNA became eligible for this study. We selected those with uncontrollable pain (score 9) and morphine-resistant. All patients received 30 cc of absolute alcohol using a 19G needle (15 cc per side), and were assessed by a questionnaire for pain intensity (0-no pain, 2-mild, 4-tolerable, 6-moderate, 8-severe, 9-incapacitating) before and 30, 60 and 90 days after EUS CPN. Results: Between January 2006 and January 2011, 208 patients became eligible. Seventy-eight were studied and controlled (mean age 63.8y, range 37-84y). EUSFNA-CPN at the same time was performed in 44 and EUS-CPN in 34 patients. The average size of tumors identified by EUS was 3.8 cm (1.5 6.2 cm). Immediately after the procedure, 25/78 (32%) had pain relief, lowering the score from 9 to 4 (10) and 6 (15). After 30 days evaluation revealed that 61/78 (78%) had pain score improved to 2 (7), 4 (32) and 6 (22), while after 60 and 90 days, pain relief occurred in 33/78 (42.3%) and 37/65 (57%). In this interval 13/78 (16.6%) died. There were mild complications (20.5%) after the procedure, all managed by conventional measures (severe diarrhea (6), postural hypotension (5), reversible (3) and irreversible (2) lower limb edema). The mean follow-up after EUS-CPN was 8.6 months (1-18 months). There was no effect on quality of life or survival. Conclusion: EUS-CPN reduces pain and can moderate morphine consumption in patients with pain related to inoperable pancreatic cancer. EUSCPN can be performed in all patients with pancreatic mass, during EUS for diagnosis and staging.