title: EUS-guided celiac plexus interventions in pancreatic cancer pain: An update and controversies for the endosonographer.
abstract: Patients with pancreatic cancer (pancreatic ductal adenocarcinoma [PDAC]) can develop abdominal pain that can be debilitating. Celiac plexus neurolysis (CPN) is a chemical ablation of the celiac plexus that can be used to treat pain caused by pancreatic malignancy. It can be performed by an anterior or posterior approach, and also can be done percutaneously or under guidance of transabdominal ultrasound, computed tomography, intra-operatively or most recently under linear endoscopic ultrasound (EUS) guidance (EUS-CPN). EUS is well-suited for identification of the celiac plexus due to the close proximity of the gastric wall to the origin of the celiac artery. EUS-CPN is now widely practiced, and different EUS approaches have been developed in order to improve the efficacy of this technique. Our objective is to review the use of EUS-CPN in PDAC, including a description of different techniques, review of its efficacy, predictors of pain response, and describe its limitations and safety, as well as new developments.
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, United States ; Gastroenterology Section, Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, United States.
authors.forename: Leticia Perondi
authors.initials: LP
authors.lastname: Luz
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, United States.
authors.forename: Mohammad Ali
authors.initials: MA
authors.lastname: Al-Haddad
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, United States.
authors.forename: John A
authors.initials: JA
authors.lastname: DeWitt
keywords: Celiac plexus neurolysis; endoscopic ultrasound; pancreatic cancer