Injection Of Absolute Alcohol Research Articles

Alcohol Septal Ablation in Patients with Hypertrophic Obstructive Cardiomyopathy: A Contemporary Perspective.

Alcohol septal ablation is a minimally invasive procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite optimal medical therapy. The procedure causes a controlled myocardial infarction of the basal portion of the interventricular septum by the injection of absolute alcohol with the aim of reducing LVOT obstruction and improving the patient's hemodynamics and symptoms. Numerous observations have demonstrated the efficacy and safety of the procedure, making it a valid alternative to surgical myectomy. In particular, the success of alcohol septal ablation depends on appropriate patient selection and the experience of the institution where the procedure is performed. In this review, we summarize the current evidence on alcohol septal ablation and highlight the importance of a multidisciplinary approach involving a team of clinical and interventional cardiologists and cardiac surgeons with high expertise in the management of HOCM patients-the Cardiomyopathy Team.

Safety of ultrasound-guided percutaneous injection of alcohol as a scolicidal agent for the treatment of liver hydatid cysts

Background: Hydatid disease is a health problem in the developing world. Percutaneous therapy with various scolicidal agents has been described; however, there is a paucity of literature on the use of absolute alcohol injection without reaspiration as a sole scolicidal agent. The study carried out in a tertiary hospital aimed to prospectively evaluate the safety and outcomes of ultrasound-guided percutaneous injection of alcohol for liver hydatid cyst. Methodology: Consecutive patients with liver hydatid cysts were evaluated with ultrasound, classified according to the WHO classification between June 2012 and January 2020. Eligible patients underwent ultrasound-guided percutaneous therapy after three courses of oral albendazole. Patients having elevated cyst fluid bilirubin levels were excluded. Patients who underwent percutaneous alcohol injection were followed up clinically and with imaging. Data were entered in Microsoft Excel spreadsheet and analyzed. Results: Fifty-two consecutive patients with hydatid cyst were evaluated during the study. Among these, 27 patients underwent percutaneous alcohol injection. Follow-up data were available for 25 patients. There was a favorable imaging outcome in 21/25 (84%). One patient developed anaphylaxis during cyst access, which was managed medically with an uneventful recovery. No instances of cholangitis or sepsis following injection were observed. Conclusion: Percutaneous alcohol injection therapy for liver hydatid cysts is a minimally invasive, safe, and an effective procedure in selected group of patients.

Management of Myelopathy due to Anterior Soft-Tissue Compression in Vertebral Hemangioma

Vertebral hemangiomas are benign but highly vascular lesions and are one of the most common lesions of the vertebral column. Anterior soft-tissue compression of spinal cord due to vertebral body hemangioma is challenging to manage. Our objective was to assess long-term clinical and radiologic effects of direct transpedicular absolute alcohol embolization, laminectomy, and short-segment instrumented fusion on resolution of extraosseous epidural soft tissue and improvement in myelopathy in cases of vertebral hemangioma causing anterior soft-tissue compression. This was a retrospective analysis that included patients with single-level vertebral hemangioma with anterior intraspinal soft-tissue growth causing spinal cord compression and clinical features of myelopathy between June 2007 and June 2019 at authors' institute. Transpedicular vertebral body injection of absolute alcohol, laminectomy, and pedicle screw rod instrumentation was performed in all patients. Clinicoradiologic outcomes of surgery were noted. We proposed a grading system for the extent of anterior extraosseous epidural soft-tissue compression. In total, 14 patients were included in study. Their mean age was 28.4 ± 14.4 years. Mean follow-up duration was 67.5 ± 36.2 months. All patients had preoperative radiologic grade 4 compression. Postoperative radiologic grading improved to grade 1 in 4 (28.6%), grade 2 in 8 (57.1%), and grade 3 in 2 (14.3%). All the patients improved neurologically after surgery. Eleven patients improved to American Spinal Injury Association (ASIA) grade E, 2 improved to ASIA D, and 1 improved to ASIA C at the last follow-up visit. Vertebral hemangiomas with anterior extraosseous epidural extension causing spinal canal compromise and myelopathy can be managed with direct transpedicular ethanol embolization, laminectomy, and short-segment instrumented fusion with resolution of the extraosseous soft tissue and improvement in myelopathy. The procedure is relatively simple, cost effective, and has a good outcome.

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy: the emerging role of the Cardiomyopathy Team

Alcohol septal ablation is a minimally invasive, safe, and effective procedure for the treatment of left ventricular outflow tract (LVOT) obstruction in patients with hypertrophic obstructive cardiomyopathy (HOCM) who remain symptomatic despite maximal medical therapy. Originally performed by Ulrich Sigwart in 1994, the procedure causes a iatrogenic infarction - through the injection of absolute alcohol - of the basal portion of the interventricular septum and aims at reducing LVOT obstruction in order to improve patient's hemodynamics and symptoms. Numerous studies have demonstrated the effectiveness and safety of the procedure, making it a valid alternative to surgical myectomy. The success of alcohol septal ablation depends upon the selection of the patient and the experience of both the operators and the center where the procedure is performed. In this review, we summarize current evidence on alcohol septal ablation, describe its procedural aspects and propose a multidisciplinary approach that involves a team of clinical cardiologists, interventionists, and cardiac surgeons, the Cardiomyopathy Team, with high experience in the clinical management of these patients.

Effects of sympathectomy on myocardium remodeling and function

OBJECTIVES:To evaluate the effects of sympathectomy on the myocardium in an experimental model.METHODS:The study evaluated three groups of male Wistar rats: control (CT; n=15), left unilateral sympathectomy (UNI; n=15), and bilateral sympathectomy (BIL; n=31). Sympathectomy was performed by injection of absolute alcohol into the space of the spinous process of the C7 vertebra. After 6 weeks, we assessed the chronotropic properties at rest and stress, cardiovascular autonomic modulation, myocardial and peripheral catecholamines, and beta-adrenergic receptors in the myocardium. The treadmill test consisted of an escalated protocol with a velocity increment until the maximal velocity tolerated by the animal was reached.RESULTS:The bilateral group had higher levels of peripheral catecholamines, and consequently, a higher heart rate (HR) and blood pressure levels. This suggests that the activation of a compensatory pathway in this group may have deleterious effects. The BIL group had basal tachycardia immediately before the exercise test and increased tachycardia at peak exercise (p<0.01); the blood pressure had the same pattern (p=0.0365). The variables related to autonomic modulation were not significantly different between groups, with the exception of the high frequency (HF) variable, which showed significant differences in CT vs UNI. There was no significant difference in beta receptor expression between groups. There was a higher concentration of peripheral norepinephrine in the BIL group (p=0.0001), and no significant difference in myocardial norepinephrine (p=0.09).CONCLUSION:These findings suggest that an extra cardiac compensatory pathway increases the sympathetic tonus and maintains a higher HR and higher levels of peripheral catecholamines in the procedure groups. The increase in HF activity can be interpreted as an attempt to increase the parasympathetic tonus to balance the greater sympathetic activity.

Portal vein ligation with alcohol injection – our first experiences

Surgical resection of colorectal liver metastases is agold standard treatment. The indication criteria still continue expanding. The future liver remnant volume (FLRV) remains the only limiting factor of the resection. Many methods have been discussed to increase the FLRV. Injection of absolute alcohol into the portal vein seems to be one of the most effective. In 2018 we perioperatively injected 25 ml of absolute alcohol into the ligated right portal branch in 3 patients with colorectal liver metastases at our department. All patients were indicated for second-stage right hemihepatectomy. The mean FLRV increase was 206.6 cm3 46 weeks after absolute alcohol injection. Atransient elevation of transaminases was observed with spontaneous regression within 10 days from alcohol injection. There was no complication clearly associated with alcohol application. No liver failure was observed. No patient died. All three patients underwent second-stage right hemihepatectomy. Portal vein ligation with alcohol injection can be an uncomplicated and highly effective method to achieve FLRV hypertrophy.

Repeated peripheral alcohol injection is an effective treatment of Trigeminal Neuralgia in non-drug compliance patients.

Introduction:Trigeminal neuralgia (TN) is an uncommon disorder seen in dental and neurologic practice, which presents with brief lancinating pain in the face, in the area distributed by the trigeminal nerve. The wide ranges of treatments currently used for TN are ample evidence that there is no simple answer to how it should be managed.Purpose:In this study, we want to evaluate, if repeated peripheral alcohol injection is an effective treatment of TN patients.Material and Methods:Retrospective data analysis of patients treated with peripheral alcohol injections from November 2011 to July 2017 were conducted. We selected the patients who reported at least three times for alcohol injection and duration of pain relief recorded as reported by patients.Results:Effects of 96% absolute alcohol injection alcohol injection ranging from 13 to 15 months pain relief, but in second or third time, this duration was decreased to 11–12 months, whereas no much significant complication were observed.Conclusion:Even single time neurectomy is not permanent cure, so patients choose less invasive option such as peripheral alcohol injections in repeated use instead of a surgical option.

The clinical study of ultrasound-guided intra-hysteromyoma injection of ethyl alcohol absolute combined with HIFU in the treatment of uterine fibroids

Abstract Objective The aim of this study was to investigate the energy deposition in the target area of high intensity focused ultrasound (HIFU) with ultrasound-guided intra-hysteromyoma injection of ethyl alcohol absolute Methods Eighty patients with hysteromyomas were randomly divided into two groups: group HIFU (group H) and group HIFU combined with ultrasound-guided intra-hysteromyoma injectionn of ethyl alcohol absolute (group E + H). Patients in group E + H received an ultrasound-guided injection of absolute ethyl alcohol 1 h before HIFU treatment. The irradiation time, irradiation dose, energy efficiency factor (radiation energy required for ablation of a myoma per unit of volume), grey variation, pain score, and adverse reactions were compared between the two groups. An independent sample t-test was used with a two-tailed P-value of &lt; 0.05. Results The irradiation time, irradiation dose, and energy efficiency factor were significantly lower in group E + H than those in group H (P &lt; 0.05). The hysteromyomas of patients in group E+H appeared as dominantly hyperechoic masses, and those of patients in group H appeared as hyperechoic tissue (non-mass). The incidence of adverse reactions and pain score were higher in group H than those in group E + H (P &lt; 0.05). Conclusion Ultrasound-guided intra-hysteromyoma injection of ethyl alcohol absolute can enhance the energy deposition of HIFU in the uterine fibroids, improve the treatment efficiency, shorten the treatment time, reduce the treatment dose, and reduce the pain and complications for the patients.

Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization

BackgroundVertebral body hemangiomas with myelopathy are difficult to manage. ObjectiveThe objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). Clinical Materials and MethodsThis prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. ResultsThe study included 33 patients (mean 26.9±13.2, range: 10–68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28–103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. ConclusionsThis is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.

PRIMARY EXPERIENCE WITH CT GUIDED MANDIBULAR NERVE BLOCK IN PATIENTS WITH TRIGEMINAL NEURALGIA

Background: Trigeminal neuralgia (TN) is a well-known facial pain syndrome characterized by excruciating paroxysmal shock pain attacks located in somato-sensensory distribution of trigeminal nerve. Mandibular affection is a common presentation of TN. Objectives: Studying the effect of injection of mandibular nerve with neurolytic solutions in trigeminal neuralgia that was unresponsive to pharmacotherapy. Patients and Method: This prospective study included 21 patients treated for mandibular neuralgia by percutaneous injection of absolute alcohol under guidance of CT image. Their ages ranged from 35-60 years and male to female was 3:4. All patients suffered from moderate to severe TN, and did not respond to medical treatment. Entry and trajectory of needle was planned by CT and after local anesthesia. Alcohol was injected at the exit of mandibular nerve from foramen ovale. Results: 85.7% of patients improved (71.4% became pain free and severity of pain decreased in 19%), while 9.6% of patients has no response after injection. The pain free patients became 61.9% after two years of follow up. Conclusion: CT guided mandibular nerve block by neurolytic agent as absolute alcohol and showed its effectiveness as minimal invasive treatment option for intractable trigeminal neuralgia. CT guidance provided a clear view to secure the safety, accuracy and selectivity of nerve block.

Retrobulbar chlorpromazine in management of painful eye in blind or low vision patients

Abstract Objective To evaluate the results of applying retrobulbar chlorpromazine in the management of patients with painful blind eyes or with very poor vision. Methods A retrospective, descriptive review was carried out on the medical records of 33 patients who were treated with a retrobulbar injection of chlorpromazine (25 mg) for the management of painful blind eyes in Centro Oftalmologico Virgilio Galvis . Results Pain control was achieved in 90% of cases (with mean follow-up of 2.1 years). The mean intraocular pressure decreased by 37%. In 7 out of 12 eyes that maintained residual vision, loss of some degree of vision was acknowledged. One patient required an additional cyclodestructive procedure, another one required an absolute alcohol injection, and in an additional case evisceration surgery was necessary to achieve pain control. No serious complications were noted with this therapy. Conclusions Retrobulbar injection of chlorpromazine is a valid option in painful, blind eye cases (or with very poor vision) with a poor visual prognosis.

Clorpromazina retrobulbar en el manejo del ojo doloroso ciego o con baja visión

ObjectiveTo evaluate the results of applying retrobulbar chlorpromazine in the management of patients with painful blind eyes or with very poor vision. MethodsA retrospective, descriptive review was carried out on the medical records of 33 patients who were treated with a retrobulbar injection of chlorpromazine (25mg) for the management of painful blind eyes in Centro Oftalmológico Virgilio Galvis. ResultsPain control was achieved in 90% of cases (with mean follow-up of 2.1 years). The mean intraocular pressure decreased by 37%. In 7 out of 12 eyes that maintained residual vision, loss of some degree of vision was acknowledged. One patient required an additional cyclodestructive procedure, another one required an absolute alcohol injection, and in an additional case evisceration surgery was necessary to achieve pain control. No serious complications were noted with this therapy. ConclusionsRetrobulbar injection of chlorpromazine is a valid option in painful, blind eye cases (or with very poor vision) with a poor visual prognosis.

The alcohol injection into portal vein prior to ligation increases hepatic regeneration rate

Introduction: The failure of portal vein ligation (PVL) to induce adequate hypertrophy might be owing to the formation of intrahepatic portoportal collaterals. The impact of alcohol injection into the portal vein prior to ligation is unknown. Aim of the study was to compare liver regeneration rate following PVL with (Alc+) and without (Alc−) simultaneous intraportal alcohol injection. Methods: The study population included all patients affected by colorectal liver metastases (CRLM) scheduled for portal vein ligation between 01/2004 and 06/2014. Since 09/2011 we associated the injection of absolute alcohol into the right portal vein prior to ligation. Data concerning future remnant liver volume (FLRV) pre and post PVL were analyzed. The FLRV as assessed by volumetric CT-scan. Liver regeneration was assessed by Volumetric Increase VI = [(FLRVpost% – FLRVpre%)/FLRVpre%]. Results: A total of 42 patients were considered: 23 in Alc+ group and 19 in Alc− group. The two groups were similar in terms of age, sex, diabetes, FLRV before PVL and administration of chemotherapy. Alcohol injection was feasible in every case and no procedure related morbidity was observed. Mean post-PVL FLRV (43.3±14.3% vs. 34.6±6.4%, p = 0.013) and VI (0.44±0.24 vs. 0.28±0.20, p = 0.029) were higher in the Alc+ group. Male sex (0.30±024 vs.0.46±0.19, p = 0.025) and portal ligation without alcohol injection (0.28±0.20 vs. 0.44±024, p = 0.029) negatively correlated with VI at univariate analysis. At multiple regression analysis both variables (male B = −0.149 p = 0.035, alcohol injection B = 0.143 p = 0.041) statistically significantly predict VI [F (1,40) = 5.200, p = 0.010]. Conclusions: Alcohol injection prior to portal vein ligation significantly increase the liver regeneration rate.

Painful lumbar Schmorl nodule mimicking osteoma osteoid

A 21-year-old man presented with complaints of nocturnal low back pain radiating to the right posterior thigh for 6 months. Aggravated by sitting position, the pain was alleviated by non-steroidal anti-inflammatory drug (NSAID). Computed tomography scan revealed an osteolytic lesion in the superior end plate of the L2 vertebra with sclerotic margins (Fig. 1, Top Left, Top Right, Bottom Left, Bottom Right). Magnetic resonance imaging showed low intense nodule with surrounding hyperintense rim in T2-weighted and hypointense in T1-weighted images (Fig. 2, Left, Middle). The patient was submitted to transpedicular biopsy and absolute alcohol injection with sciatic pain control (Fig. 2, Right). Pathology confirmed herniated disc material (Schmorl nodule). Low back pain was completely resolved with COX-2 non-steroidal anti-inflammatory drug for several years. Fig. 2Magnetic resonance image: (Left) pre-biopsy T1-weighted image; (Middle) pre-biopsy T2-weighted image; and (Right) post-alcohol injection showing reduction in volume. View Large Image Figure Viewer Download Hi-res image

Management of pediatric single-level vertebral hemangiomas presenting with myelopathy by three-pronged approach (ethanol embolization, laminectomy, and instrumentation): a single-institute experience.

Pediatric vertebral hemangiomas (VH) are exceedingly rare benign and highly vascular tumours of the spine. There are no guidelines available for management of these patients in literature. Purpose of this study is to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented fusion in pediatric symptomatic VH with single-level involvement. Surgery consisted of intraoperative bilateral pedicular absolute alcohol injection and laminectomy at the level of pathology followed by a short-/long-segment instrumented fusion using pedicle screws and rod. Seven patients (mean age 14 ± 2.4 years, range 10-17 years, five females and two males) (age < 18 years) who were treated using this technique at our institute since March 2008 to December 2013 were enrolled in this retrospective study. Demographical, clinical, radiological, operative details, and postoperative events were retrieved from hospital records. During follow-up visits, clinical status and imaging were recorded. Outcome assessed with clinical and neurological outcome score of American Spinal Injury Association (ASIA) Impairment Scale. Duration of symptoms ranged from 3 to 60 months (mean, 14.7 ± 20.4 months). Clinical features include myelopathy with motor and sensory involvement in all (five were paraplegic), back pain in two patients, and bladder involvement in two patients. The preoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS) were B in five patients and C and D in one patient each. All had pan vertebral body VH with severe cord compression in the thoracic region on imaging study. Mean duration of surgery was 248.6 ± 60 minutes (range 195-310 min) and blood loss was 535 ml (range 200-1500 ml). Immediate embolization was achieved in all patients, which allowed laminectomy and soft tissue hemangioma removal relatively easy. Post surgery, at mean follow-up of 45.3 (±23.2) months (range 1-78 months), all patients showed improvement in power (sphincter improvement in two patients). ASIA were E in six patients and D in one patient at the last follow-up. The present study is the largest series of pediatric symptomatic VH. This procedure is a safe, efficient method to treat symptomatic pediatric VH with severe cord compression. It seems to serve the purpose of providing embolization, cord decompression, rigid fusion at the same sitting without adding new morbidity, and preventing excessive blood loss.

Intratumoural injection of absolute alcohol in carcinoma of gastroesophageal junction for palliation of dysphagia.

Background:Ethanol-induced tumour necrosis (ETN) is a simple, readily available palliative treatment for patients with inoperable carcinoma of the oesophagus with poor performance status. In India, capital outlay needed for stenting or laser therapy is out of reach. Hence, we took up this study to calculate the effect of intratumoral injection of absolute alcohol in palliation of dysphagia due to carcinoma of the oesophagogastric junction and to monitor the improvement in quality of life (QOL).Methods:A total of 16 patients with a mean age of 56.2 ± 7.5 years with dysphagia due to unresectable malignant oesophageal strictures involving the oesophagogastric junction were included in the study. Six to ten cubic centimetres of absolute alcohol in 1 cc aliquots was injected circumferentially into the tumour at the point of luminal obstruction using disposable sclerosing needles (23G). During each follow up dysphagia grade, QOL score and complications, if any, were noted.Results:The mean alcohol injected per session was 6.9 ± 1.8 cc. The mean dysphagia grade improved from 5.5 ± 0.5 to 2.5 ± 1.1 before and after alcohol injection, respectively (p < 0.001). The time taken for recurrence of dysphagia ranged from 14 to 80 days with a median of 28 days. The mean QOL score assessed by modified EORTC questionnaire improved from a mean of 63.6 ± 6.9 to 92.6 ± 13.9 (p < 0.001). The dysphagia free survival ranged from 23 to 175 days with a mean of 71.2 days. Complications included oesophageal perforation in one patient and death in one patient.Conclusion:The endoscopic intratumoral injection of absolute alcohol significantly improves dysphagia and QOL. It is inexpensive and easy to perform.

Two-stage surgical management of multilevel symptomatic thoracic haemangioma using ethanol and iliac crest bone graft.

This article presents a 56-year-old obese female who presented with back pain and progressive weakness in her lower limbs for three months. She was bed-ridden for one week before reporting to our hospital. Plain radiographs showed vertical striations in multiple vertebrae classical of haemangioma. Magnetic resonance imaging (MRI) spine revealed multiple thoracic and lumbar vertebral haemangiomas. Extra osseous extension of haemangioma at T12 was causing spinal cord compression. Two-stage surgery was performed with absolute alcohol (ethanol) injection followed by pedicle screw fixation and decompression with tricortical iliac crest bone graft into the vertebral body. Postoperatively rapid neurological improvement was seen. After three weeks, she could walk independently. One year later, computed tomography showed complete incorporation of bone graft and maintained vertebral body height. MRI showed complete resolution of the cord edema at T12. These findings indicated diminished vascularity of the tumor.

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy – 8 years follow up

BackgroundAlcohol septal ablation is emerging as an alternative to surgical myectomy in the management of symptomatic cases of Hypertrophic obstructive cardiomyopathy (HOCM). This involves injection of absolute alcohol into 1st septal perforator thereby producing myocardial necrosis with resultant septal remodelling within 3–6 months. This results in reduction of septal thickness and LV outflow gradients with improvement in symptoms.MethodsFifty three patients had undergone alcohol septal ablation, there were 2 early and 2 late deaths and 4 patients lost to follow up. Forty-five (85%) of them were followed up to a mean period of 96 ± 9.2 months. Clinical, ECG, and Echocardiographic parameters were evaluated during follow up.ResultsOnly 4 out of 51 patients remained in NYHA class III or IV at the end of 6 months. Significant reduction of LV outflow gradients (79 ± 35 to 34 ± 23 mmHg) and septal thickness (23 ± 4.7 mm to 19 ± 3 mm) were observed during 6 months follow up. Beyond 6 months there was no further decrease in either septal thickness or LVOT gradients noted. Ten percent of patients needed pacemaker implantation. There was 92% survival at the end of 8 years.ConclusionAlcohol septal ablation is a safe and effective nonsurgical procedure for the treatment of HOCM. By minimizing the amount of alcohol to ≤2 ml, one can reduce complications and mortality. The long-term survival is gratifying.

Management of Chronic Pancreatitis

Advances in our understanding of chronic pancreatitis have improved our care of patients with this disease. Although our therapies are imperfect and many patients remain symptomatic, appropriate medical care improves the quality of life in these patients. Proper management requires an accurate diagnosis, recognition of the modifiable causes of disease, assessment of symptoms and complications, treatment of these symptoms and complications utilizing a multidisciplinary team, and ongoing monitoring for the effect of therapy and the occurrence of complications.

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

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.