Initial evaluation of the efficacy and safety of endoscopic ultrasound-guided direct Ganglia neurolysis and block.
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.
Levy
Michael J
MJ
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Topazian
Mark D
MD
Wiersema
Maurits J
MJ
Clain
Jonathan E
JE
Rajan
Elizabeth
E
Wang
Kenneth K
KK
de la Mora
Jose G
JG
Gleeson
Ferga C
FC
Pearson
Randall K
RK
Pelaez
Mario C
MC
Petersen
Bret T
BT
Vege
Santhi S
SS
Chari
Suresh T
ST
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
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D012997:Solvents; D000431:Ethanol; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone; D002045:Bupivacaine