title: Echoendoscopic ethanol ablation of tumor combined with celiac plexus neurolysis in patients with pancreatic adenocarcinoma.
abstract: OBJECTIVE
  Endoscopic ultrasonography guided-celiac plexus neurolysis relieves pain in patients with pancreatic cancer but with often suboptimal and transient results. The study aims to compare the efficacy and safety of endoscopic ultrasound-guided tumor ethanol ablation combined with celiac plexus neurolysis with respect to celiac plexus neurolysis alone for pain management in patients with pancreatic cancer.
  
  
  METHODS
  Among 123 patients with unresectable pancreatic cancer referred to our Institution between 2006 and 2014, 58 treated with endoscopic ultrasound-guided celiac plexus neurolysis (Group 1) and 65 with the combined approach (Group 2) were compared. Logistic regression models were applied to identify predictors of pain relief.
  
  
  RESULTS
  The two groups presented similar baseline clinical and tumoral parameters. Pre-procedural visual analog scale score was 7 in both groups (P = 0.8), and tumor max diameter was 38 mm (range 25-59) in Group 1 and 43 mm (22-59) in Group 2 (P = 0.4). The combined treatment increased pain relief and complete pain response rate (P = 0.005 and 0.003, respectively). Median duration of pain relief was 10 (7-14) and 18 (13-20) weeks in the two groups, respectively (P = 0.004). At multivariate regression, initial visual analog scale score and endoscopic technique adopted resulted significantly associated with pain relief. No severe treatment-related adverse events were reported. Median overall survival was 6.5 months (5.1-8.6) in Group 1 and 8.3 months (6-11.4) in Group 2 (P = 0.05).
  
  
  CONCLUSIONS
  Endoscopic ultrasound-guided tumor ablation combined with celiac plexus neurolysis appears to be superior to celiac plexus neurolysis alone in terms of pain control and overall survival.
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Facciorusso
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Di Maso
authors.affiliation: Internal Medicine Unit, University of Foggia, Foggia, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Serviddio
authors.affiliation: Digestive Endoscopic Unit, Catholic University, Rome, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Larghi
authors.affiliation: Digestive Endoscopic Unit, Catholic University, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Costamagna
authors.affiliation: Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Muscatiello
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072716:Cancer Pain / Q000209:etiology / Q000628:therapy*; D002447:Celiac Plexus; D003131:Combined Modality Therapy; D019160:Endosonography; D000431:Ethanol; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000431:Ethanol
keywords: CPN; EUS; Pancreas cancer; ethanol injection