EUS-guided broad plexus neurolysis over the superior mesenteric artery using a 25-gauge needle.
OBJECTIVE
Endoscopic ultrasonography (EUS)-guided celiac plexus neurolysis (EUS-CPN) is safe and effective but not beneficial for some patients with extended abdominal cancer. We compared the effectiveness of standard EUS-CPN and EUS-guided broad plexus neurolysis (EUS-BPN) that extends over the superior mesenteric artery (SMA) using a 25-gauge needle.


METHODS
Consecutive patients referred to our quaternary EUS centers were eligible for inclusion. To evaluate the neurolytic spread, contrast was mixed with the neurolytic agent and post-procedure computed tomography scanning was performed. The regions containing the celiac, superior, and inferior mesenteric arteries were divided on the frontal plane into six areas: upper right and left, middle right and left, and lower right and left. The number of contrast-bearing areas after EUS-CPN and EUS-BPN were related to the degree of pain relief achieved.


RESULTS
A total of 67 patients with advanced abdominal cancer were included (34 EUS-CPN and 33 EUS-BPN). The qualitative variables of the two groups did not differ significantly. The EUS-BPN group had more patients with six contrast-bearing areas (42%) than the EUS-CPN group (0%). These patients had significantly better short-term and long-lasting pain relief than patients with less than five contrast-bearing areas. EUS-BPN patients exhibited significantly greater reductions in days 7 and 30 visual analog pain scale scores than EUS-CPN patients.


CONCLUSIONS
Our preliminary data suggested that EUS-BPN using a 25-gauge needle provides patients with advanced abdominal cancer with better pain relief than standard EUS-CPN, and without incurring serious complications. Moreover, it seems that broad neurolysis over the SMA may provide superior analgesia.
Sakamoto
Hiroki
H
Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osakasayama City, Osaka, Japan. hiroki.sakamoto@nifty.com
Kitano
Masayuki
M
Kamata
Ken
K
Komaki
Takamitsu
T
Imai
Hajime
H
Chikugo
Takaaki
T
Takeyama
Yoshifumi
Y
Kudo
Masatoshi
M
D000008:Abdominal Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D000368:Aged; D001340:Autonomic Nerve Block / Q000379:methods*; D002447:Celiac Plexus / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D003287:Contrast Media; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D009339:Needles; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D003287:Contrast Media