title: EUS visualization and direct celiac ganglia neurolysis predicts better pain relief in patients with pancreatic malignancy (with video).
abstract: BACKGROUND
  EUS-guided celiac plexus neurolysis (EUS-CPN) improves pain control in patients with pancreatic cancer. EUS allows visualization of the celiac ganglion.
  
  
  OBJECTIVE
  To determine predictors of response to EUS-CPN in a cohort of 64 patients with pancreatic malignancy.
  
  
  METHODS
  Retrospective analysis of prospective database.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Sixty-four patients with pancreatic cancer referred for EUS between March 2008 and January 2010.
  
  
  METHODS
  EUS-CPN injected directly into celiac ganglia when visible by linear EUS or bilateral injection at the celiac vascular trunk.
  
  
  METHODS
  Predictors of pain improvement at week 1 by univariate and multivariate analysis.
  
  
  RESULTS
  At week 1, 32 patients (50%) had a symptomatic response. In a multivariate model with 8 potential predictors, visualization of the ganglia was the best predictor of response; patients with visible ganglia were >15 times more likely to respond (odds ratio 15.7; P<.001). Tumors located outside the head of the pancreas and patients with a higher baseline pain level were weakly associated with a good response.
  
  
  CONCLUSIONS
  Retrospective design and lack of blinding.
  
  
  CONCLUSIONS
  Visualization of celiac ganglia with direct injection is the best predictor of response to EUS-CPN in patients with pancreatic malignancy.
authors.affiliation: Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
authors.forename: Gil
authors.initials: G
authors.lastname: Ascunce
authors.forename: Afonso
authors.initials: A
authors.lastname: Ribeiro
authors.forename: Isildinha
authors.initials: I
authors.lastname: Reis
authors.forename: Caio
authors.initials: C
authors.lastname: Rocha-Lima
authors.forename: Danny
authors.initials: D
authors.lastname: Sleeman
authors.forename: Jaime
authors.initials: J
authors.lastname: Merchan
authors.forename: Joe
authors.initials: J
authors.lastname: Levi
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia / Q000379:methods; D001340:Autonomic Nerve Block / Q000379:methods; D002447:Celiac Plexus / Q000187:drug effects / Q000648:ultrastructure*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D011379:Prognosis; D012189:Retrospective Studies