title: Intraprocedural increase in heart rate during EUS-guided celiac plexus neurolysis: Clinically relevant or just a physiologic change?
abstract: OBJECTIVE
  Although EUS-guided celiac plexus neurolysis (EUS-CPN) is performed frequently for palliation of pain in pancreatic cancer, response to treatment is variable. Although intraprocedural increases in heart rate during alcohol injection are observed frequently, their significance and relationship to treatment outcome are unknown. The objective of this study was to examine whether a correlation exists between an increase in heart rate and treatment outcomes in patients undergoing EUS-CPN for pain relief in pancreatic cancer.
  
  
  METHODS
  This is a prospective observational study of patients with abdominal pain caused by inoperable pancreatic cancer who underwent EUS-CPN. Heart rate change was defined as an increase of ≥15 beats per minute (bpm) for ≥30 seconds during alcohol injection. Main outcome measures were to compare pain, quality of life, opioid use, and survival between heart rate change and no-change groups.
  
  
  RESULTS
  Heart rate change was observed in 25 of 51 patients (49.0%) who underwent EUS-CPN over a 12-month period. Although the heart rate change cohort had significantly better adjusted scores for pain (60 vs 73; P = .042) and components of quality of life such as nausea and/or vomiting (65 vs 81; P = .004), financial difficulties (41 vs 57; P = .02), weight loss (45 vs 65; P = .007), and satisfaction with body image (52 vs 62; P = .035), there was no significant difference in postprocedural opioid use or survival between groups.
  
  
  CONCLUSIONS
  Because patients with an increase in intraprocedural heart rate experienced significant improvement in pain and quality of life components, this observation must be further explored in order to improve the technique and outcomes of EUS-CPN.
authors.affiliation: Division of Gastroenterology-Hepatology, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Bang
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Muhammad K
authors.initials: MK
authors.lastname: Hasan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Bryce
authors.initials: B
authors.lastname: Sutton
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Bronte A
authors.initials: BA
authors.lastname: Holt
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Udayakumar
authors.initials: U
authors.lastname: Navaneethan
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Hawes
authors.affiliation: Center for Interventional Endoscopy, Florida Hospital, Orlando, Florida, USA.
authors.forename: Shyam
authors.initials: S
authors.lastname: Varadarajulu
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D001340:Autonomic Nerve Block / Q000009:adverse effects / Q000379:methods; D002447:Celiac Plexus; D019160:Endosonography; D005260:Female; D006339:Heart Rate; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010190:Pancreatic Neoplasms / Q000150:complications*; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid