title: Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block.
abstract: BACKGROUND
  Celiac plexus neurolysis and block are considered safe but provide limited pain relief. Standard techniques target the region of the celiac plexus but do not attempt injections directly into celiac ganglia. The recent recognition that celiac ganglia can be visualized by endoscopic ultrasound (EUS) now allows direct injection into celiac ganglia for neurolysis (CGN) and block (CGB).
  
  
  OBJECTIVE
  To determine the safety and initial efficacy (at 2-4 wk) of direct ganglia injection in patients with moderate to severe pain secondary to unresectable pancreatic carcinoma or chronic pancreatitis.
  
  
  METHODS
  An EUS database was reviewed to identify patients undergoing CGN and CGB. Data were retrieved from the medical records and phone follow-up.
  
  
  RESULTS
  Thirty-three patients underwent 36 direct celiac ganglia injections for unresectable pancreatic cancer (CGN N = 17, CGB N = 1) or chronic pancreatitis (CGN N = 5, CGB N = 13) with bupivacaine (0.25%) and alcohol (99%) for CGN, or Depo-Medrol (80 mg/2 cc) for CGB. Cancer patients reported pain relief in 16/17 (94%) when alcohol was injected and 0/1 (00%) when steroid was injected. For chronic pancreatitis, 4/5 (80%) who received alcohol reported pain relief versus 5/13 (38%) receiving steroids. Thirteen (34%) patients experienced initial pain exacerbation, which correlated with improved therapeutic response (P < 0.05). Transient hypotension and diarrhea developed in 12 and 6 patients, respectively.
  
  
  CONCLUSIONS
  Initial experience suggests that EUS-guided direct celiac ganglion block or neurolysis is safe. Alcohol injection into ganglia appears to be effective in both cancer and chronic pancreatitis. Prospective trials are needed to confirm the efficacy of this new approach.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Levy
authors.forename: Mark D
authors.initials: MD
authors.lastname: Topazian
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Clain
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Rajan
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Jose G
authors.initials: JG
authors.lastname: de la Mora
authors.forename: Ferga C
authors.initials: FC
authors.lastname: Gleeson
authors.forename: Randall K
authors.initials: RK
authors.lastname: Pearson
authors.forename: Mario C
authors.initials: MC
authors.lastname: Pelaez
authors.forename: Bret T
authors.initials: BT
authors.lastname: Petersen
authors.forename: Santhi S
authors.initials: SS
authors.lastname: Vege
authors.forename: Suresh T
authors.initials: ST
authors.lastname: Chari
mesh_terms: D015746:Abdominal Pain / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D001340:Autonomic Nerve Block / Q000379:methods*; D001706:Biopsy; D002045:Bupivacaine; D002447:Celiac Plexus; D019160:Endosonography / Q000379:methods*; D000431:Ethanol; D005260:Female; D005728:Ganglia, Sympathetic; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008775:Methylprednisolone / Q000031:analogs & derivatives; D000077555:Methylprednisolone Acetate; D008875:Middle Aged; D009367:Neoplasm Staging; D010147:Pain Measurement; D010179:Pancreas / Q000294:innervation; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D050500:Pancreatitis, Chronic / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D010865:Pilot Projects; D012997:Solvents; D013563:Sympathectomy, Chemical / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D012997:Solvents; D000431:Ethanol; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone; D002045:Bupivacaine