title: Endoscopic ultrasound-guided celiac ganglia neurolysis vs. celiac plexus neurolysis: a randomized multicenter trial.
abstract: OBJECTIVE
  No prospective comparison of endoscopic ultrasonography-guided direct celiac ganglia neurolysis (EUS - CGN) vs. EUS-guided celiac plexus neurolysis (EUS - CPN) has been reported. The aim of the current study was to compare the effectiveness of EUS - CGN and EUS - CPN in providing pain relief from upper abdominal cancer pain in a multicenter randomized controlled trial.
  
  
  METHODS
  Patients with upper abdominal cancer pain were randomly assigned to treatment using either EUS - CGN or EUS - CPN. Evaluation was performed at Day 7 postoperatively using a pain scale of 0 to 10. Patients for whom pain decreased to ≤ 3 were considered to have a positive response, and those experiencing a decrease in pain to ≤ 1 were considered to be completely responsive. Comparison between the two groups was performed using intention-to-treat analysis. The primary endpoint was the difference in treatment response rates between EUS - CGN and EUS - CPN at postoperative Day 7. Secondary endpoints included differences in complete response rates, pain scores, duration of pain relief, and incidence of adverse effects.
  
  
  RESULTS
  A total of 34 patients were assigned to each group. Visualization of ganglia was possible in 30 cases (88 %) in the EUS - CGN group. The positive response rate was significantly higher in the EUS - CGN group (73.5 %) than in the EUS - CPN group (45.5 %; P = 0.026). The complete response rate was also significantly higher in the EUS - CGN group (50.0 %) than in the EUS - CPN group (18.2 %; P = 0.010). There was no difference in adverse events or duration of pain relief between the two groups.
  
  
  CONCLUSIONS
  EUS - CGN is significantly superior to conventional EUS - CPN in cancer pain relief.
  
  
  BACKGROUND
  http://www.umin.ac.jp/ctr/index.htm (ID: UMIN-000002536).
authors.affiliation: First Department of Internal Medicine, Gifu University Hospital, Gifu 501-1194, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Doi
authors.forename: I
authors.initials: I
authors.lastname: Yasuda
authors.forename: H
authors.initials: H
authors.lastname: Kawakami
authors.forename: T
authors.initials: T
authors.lastname: Hayashi
authors.forename: H
authors.initials: H
authors.lastname: Hisai
authors.forename: A
authors.initials: A
authors.lastname: Irisawa
authors.forename: T
authors.initials: T
authors.lastname: Mukai
authors.forename: A
authors.initials: A
authors.lastname: Katanuma
authors.forename: K
authors.initials: K
authors.lastname: Kubota
authors.forename: T
authors.initials: T
authors.lastname: Ohnishi
authors.forename: S
authors.initials: S
authors.lastname: Ryozawa
authors.forename: K
authors.initials: K
authors.lastname: Hara
authors.forename: T
authors.initials: T
authors.lastname: Itoi
authors.forename: K
authors.initials: K
authors.lastname: Hanada
authors.forename: K
authors.initials: K
authors.lastname: Yamao
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local; D001340:Autonomic Nerve Block / Q000379:methods*; D002045:Bupivacaine; D002447:Celiac Plexus; D019160:Endosonography; D000431:Ethanol / Q000627:therapeutic use; D005260:Female; D005728:Ganglia, Sympathetic; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications*; D018084:Ultrasonography, Interventional
chemical_list: D000779:Anesthetics, Local; D000431:Ethanol; D002045:Bupivacaine