title: Predictive factors for pain relief after endoscopic ultrasound-guided celiac plexus neurolysis.
abstract: BACKGROUND
  Celiac plexus neurolysis (CPN) is an established treatment for upper abdominal cancer pain. Recently, endoscopic ultrasound-guided CPN (EUS-CPN) was introduced and has enabled the performance of CPN under real-time imaging guidance, thereby making this technique much safer and easier. However, this procedure is not always efficacious, and a limited number of patients benefit from it. It should not be recommended for patients suspected of having unfavorable outcomes. We determined the predictive factors for response to EUS-CPN in order to enable rational selection of the therapeutic strategy.
  
  
  METHODS
  Forty-seven consecutive patients who underwent EUS-CPN at our institutions were eligible for this study. Absolute ethanol containing a contrast medium was injected just above the origin of the celiac trunk from the aorta under real-time EUS guidance, and abdominal computed tomography was performed immediately after the procedure to evaluate the distribution of the injected ethanol. The efficacy in pain relief was evaluated based on the pain score at day 7 after EUS-CPN.
  
  
  RESULTS
  Pain relief was obtained in 32 patients (68.1%). Multivariate analysis using a multiple logistic regression model revealed that direct invasion of the celiac plexus and distribution of ethanol only on the left side of the celiac artery were significant factors for a negative response to EUS-CPN (odds ratio = 4.82 and 8.67, P = 0.0387 and 0.0224, respectively).
  
  
  CONCLUSIONS
  EUS-CPN seems to be less effective in patients with direct invasion of the celiac plexus. Ethanol should be injected on both sides of the celiac axis to obtain greater pain relief.
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Iwata
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yasuda
authors.forename: Masamichi
authors.initials: M
authors.lastname: Enya
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mukai
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakashima
authors.forename: Shinpei
authors.initials: S
authors.lastname: Doi
authors.forename: Takuji
authors.initials: T
authors.lastname: Iwashita
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tomita
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D015746:Abdominal Pain / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000379:methods*; D001650:Bile Duct Neoplasms / Q000503:physiopathology*; D002447:Celiac Plexus / Q000000981:diagnostic imaging / Q000601:surgery*; D019160:Endosonography / Q000295:instrumentation*; D000431:Ethanol / Q000008:administration & dosage; D005260:Female; D005706:Gallbladder Neoplasms / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation*; D018084:Ultrasonography, Interventional / Q000295:instrumentation*
chemical_list: D000701:Analgesics, Opioid; D000431:Ethanol