Endoscopic ultrasound-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer.
BACKGROUND
The treatment of pain in patients with pancreatic cancer is a difficult topic for the patients and their physicians. There are different treatment modalities with variable results. Celiac plexus neurolysis (CPN) is a technique with good previous results using fluoroscopy, CT guidance and recently, guided by endoscopic ultrasound (EUS). The aim of this study is to report the experience of EUS guided CPN (EUS CPN) for treatment of abdominal pain in patients with unresectable pancreatic cancer.


METHODS
Patients with inoperable pancreatic cancer diagnosed by CT, MRI and/or EUS were included. The measurement of pain was made with a visual analog pain scale applied before and after the procedure. Follow up was made at weeks 2 and 4 after the procedure. The use of morphine before and after EUS CPN was evaluated. Complications related to the procedure were recorded.


RESULTS
Eleven patients (five men and six women) underwent to the procedure, the mean age was 59 years (range 43-82). In follow-up at four weeks after the procedure, pain scores were reduced by at least 5 points of visual analog pain scale in 9 (72.2%) patients. At least a fifty percent reduction in pain or more was documented in 7 (63.6%) patients. Five patients substantially reduced their pain medication. No complications were seen in this study.


CONCLUSIONS
The EUS NPC is an efficient and safe method for pain treatment in those patients with inoperable pancreatic cancer.
Ramirez-Luna
M A
MA
Department of Endoscopy, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Chavez-Tapia
N C
NC
Franco-Guzman
A M
AM
Garcia-Saenz-de Sicilia
M
M
Tellez-Avila
F I
FI
D015746:Abdominal Pain / Q000209:etiology* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002447:Celiac Plexus / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional