Endosonography-guided celiac plexus neurolysis.
BACKGROUND
We have evaluated the safety and efficacy of performing endosonography-guided celiac plexus neurolysis (EUS CPN) in patients with pain due to intra-abdominal malignancies.


METHODS
Thirty patients with upper abdominal pain requiring narcotic analgesia and suspected or known intra-abdominal malignancy were selected for EUS CPN. This group included 25 patients with pancreas carcinoma and 5 patients with intra-abdominal metastases. Using the linear array ultrasound endoscope and a prototype needle catheter, transgastric injection of the celiac plexus with bupivacaine and 98% dehydrated absolute alcohol was accomplished.


RESULTS
Pain scores were significantly lower compared with baseline at 2, 4, 8, and 12 weeks after EUS CPN (median follow-up: 10 weeks). At these follow-up intervals, 82% to 91% of patients required the same or less pain medication and 79% to 88% of patients had persistent improvement in their pain score. Comparison of patients with TXNXM1 versus TXNXMO pancreatic carcinoma revealed higher initial pain scores (7.9 +/- 1.92 versus 5.8 +/- 2.0, p = .02) and a greater decline in pain scores (decrease of 6.1 +/- 3.1 versus 4.8 +/- 2.0, p = .004). Complications were minor and consisted of transient diarrhea in four patients.


CONCLUSIONS
EUS CPN is a safe and effective means for improving pain control in patients with intra-abdominal malignancy. The technique may be performed as an outpatient at the same setting as the EUS staging examination.
Wiersema
M J
MJ
Department of Medicine, St. Vincent Hospitals, Indianapolis, Indiana, USA.
Wiersema
L M
LM
D000008:Abdominal Neoplasms / Q000503:physiopathology; D000368:Aged; D000779:Anesthetics, Local; D001340:Autonomic Nerve Block / Q000379:methods*; D002045:Bupivacaine; D002447:Celiac Plexus; D019160:Endosonography; D000431:Ethanol; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010148:Intractable Pain / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000503:physiopathology
D000779:Anesthetics, Local; D000431:Ethanol; D002045:Bupivacaine