title: EUS-guided celiac ganglion irradiation with iodine-125 seeds for pain control in pancreatic carcinoma: a prospective pilot study.
abstract: BACKGROUND
  Celiac plexus neurolysis for the palliative reduction of pain in unresectable pancreatic carcinoma (PC) is safe but provides limited relief. In a previous study, we found that EUS-guided implantation of iodine-125 ((125)I) around the celiac ganglia is a safe procedure and can induce apoptosis of local neurons in a porcine model.
  
  
  OBJECTIVE
  To evaluate the safety and efficacy of direct celiac ganglion irradiation with (125)I seeds for the relief of moderate to severe pain secondary to unresectable PC.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Single, tertiary care referral center.
  
  
  METHODS
  This study enrolled consecutive patients who had moderate to severe pain resulting from biopsy-proven unresectable PC.
  
  
  METHODS
  All patients underwent EUS-guided direct celiac ganglion irradiation with (125)I seeds. Follow-up was conducted at least once weekly until death.
  
  
  METHODS
  Blood parameters, Visual Analog Scale (VAS) score, mean analgesic (MS Contin [morphine sulfate]) consumption, and complications were evaluated during follow-up.
  
  
  RESULTS
  Twenty-three patients with unresectable PC underwent the procedure. The mean number of seeds implanted in the celiac ganglion per patient was 4 (range 2-6). Immediately after the procedure, pain relief and analgesic consumption showed no significant changes compared with preoperative values. Six patients (26%) reported pain exacerbation. Two weeks later, the VAS score and mean analgesic consumption were significantly less than preoperative values. No procedure-related deaths or major complications occurred.
  
  
  CONCLUSIONS
  Uncontrolled study.
  
  
  CONCLUSIONS
  EUS-guided direct celiac ganglion irradiation with (125)I seeds can reduce the VAS score and analgesic drug consumption in patients with unresectable PC.
authors: Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors: Kai-Xuan
authors: KX
authors: Wang
authors: Zhen-Dong
authors: ZD
authors: Jin
authors: Yi-Qi
authors: YQ
authors: Du
authors: Xian-Bao
authors: XB
authors: Zhan
authors: Duo-Wu
authors: DW
authors: Zou
authors: Yan
authors: Y
authors: Liu
authors: Dong
authors: D
authors: Wang
authors: Jie
authors: J
authors: Chen
authors: Can
authors: C
authors: Xu
authors: Zhao-Shen
authors: ZS
authors: Li
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D001918:Brachytherapy / Q000009:adverse effects; D002277:Carcinoma / Q000150:complications*; D019160:Endosonography; D005260:Female; D005728:Ganglia, Sympathetic / Q000000981:diagnostic imaging; D006801:Humans; D007457:Iodine Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000532:radiotherapy*; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications*; D010865:Pilot Projects; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D007457:Iodine Radioisotopes; D009020:Morphine