title: Celiac plexus neurolysis in the management of unresectable pancreatic cancer: when and how?
abstract: Pancreatic cancer is the second most common abdominal cancer in North America with an estimated 20% resectability at diagnosis, and overall 5-year survival of 5%. Pain is common in pancreatic cancer patients with 70%-80% suffering substantial pain. Celiac plexus neurolysis (CPN) is a technique that can potentially improve pain control in pancreatic cancer while preventing further escalation of opioid consumption. CPN is performed by injecting absolute alcohol into the celiac plexus neural network of ganglia. This review sets out to explore the current status of CPN in non-resectable pancreatic cancer. We will examine: (1) the efficacy and safety of percutaneous-CPN and endoscopic ultrasound guided-CPN; (2) specific technique modifications including bilateral (vs central) injections and celiac ganglia neurolysis; and (3) the issue of CPN timing, early at pancreatic cancer diagnosis vs traditional late use as salvage therapy.
authors.affiliation: Jonathan M Wyse, Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal H3T 1E2, Quebec, Canada.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Wyse
authors.affiliation: Jonathan M Wyse, Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal H3T 1E2, Quebec, Canada.
authors.forename: Yen-I
authors.initials: YI
authors.lastname: Chen
authors.affiliation: Jonathan M Wyse, Division of Gastroenterology, Jewish General Hospital, McGill University, Montreal H3T 1E2, Quebec, Canada.
authors.forename: Anand V
authors.initials: AV
authors.lastname: Sahai
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000701:Analgesics, Opioid / Q000627:therapeutic use; D002447:Celiac Plexus; D019160:Endosonography; D006801:Humans; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid
keywords: Celiac plexus neurolysis; Endoscopic ultrasound; Gastrointestinal endoscopy; Opioid; Pain; Pancreatic cancer