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Endoscopic ultrasonography guided celiac plexus neurolysis and celiac plexus block in the management of pain due to pancreatic cancer and chronic pancreatitis

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World Journal of Gastroenterology 2007年第26期13卷 3575-3580页

作者： Anthony J Michaels Peter V Draganov University of Florida Department of GastroenterologyHepatology and NutritionUnited States

Pain is a common symptom of pancreatic disease and is frequently difficult to manage. Pain relief provided by narcotics is often suboptimal and is associated with significant side effects. An alternative approach to pain management in pancreatic disease is the use of celiac plexus block (CPB) or neurolysis (CPN). Originally performed by anesthesiologists and radiologists via a posterior approach,recent advances in endoscopic ultrasonography (EUS) have made this technique an attractive alternative. EUS guided celiac plexus block/ neurolysis is simple to perform and avoids serious complications such as paraplegia or pneumothorax that are associated with the posterior approach. EUS guided CPN should be considered first line therapy in patients with pain due to pancreatic cancer. It provides superior pain control compared to traditional management with narcotics. A trend for improved survival in pancreatic cancer patients treated with CPN has been reported,but larger studies are needed to confirm this finding. At this time,the use of EUS guided CPB cannot be recommended as routine therapy for pain in chronic pancreatitis since only one-half of the patients experience pain reduction and the beneficial effect tends to be short lived. EUS guided CPB and CPN should be used as part of a multidisciplinary team approach for pain management.

关键词： celiac plexus celiac plexus neurolysis celiacplexus block Endoscopic ultrasound Pain management

Endoscopic ultrasound-guided celiac plexus neurolysis using a reverse phase polymer

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World Journal of Gastroenterology 2010年第6期16卷 728-731页

作者： Keith L Obstein Fernanda P Martins Gloria Fernández-Esparrach Christopher C Thompson Gastroenterology Division Brigham and Women's Hospital Federal University of So Paulo Department of Gastroenterology Endoscopy UnitHospital Clinic(Spain)

AIM:To assess the feasibility of endoscopic ultrasound(EUS)guided celiac plexus neurolysis(CPN) using a poloxamer. METHODS:In this prospective evaluation,six Yorkshire pigs underwent EUS-guided *** received an injection of 10 mL of 0.25%Lidocaine plus methylene blue(group 1) and three received an injection of 10 mL of 0.25%Lidocaine plus blue colored poloxamer(PS137-25)(group 2) .Necropsy was performed immediately after the animals were *** abdominal and pelvic cavities were examined for the presence of methylene blue and the blue colored ***:EUS-guided CPN was successfully performed in all 6 pigs without immediate *** blue was identified throughout the peritoneal and retroperitoneal cavity in group *** blue colored poloxamer was found in the retroperitoneal cavity immediately adjacent to the aorta,in the exact location of the celiac plexus in group ***:EUS-guided CPN using a reverse phase polymer in a non-survival porcine model was technically *** presence of a poloxamer gel at the site of the celiac plexus at necropsy indicates a precise delivery of the neurolytic agent.

关键词： celiac plexus neurolysis celiac plexus blockade Endoscopic ultrasound Polymer

Phenol-based endoscopic ultrasound-guided celiac plexus neurolysis for East Asian alcohol-intolerant upper gastrointestinal cancer patients:A pilot study

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World Journal of Gastroenterology 2014年第30期20卷 10512-10517页

作者： Hirotoshi Ishiwatari Tsuyoshi Hayashi Makoto Yoshida Michihiro Ono Hiroyuki Masuko Tsutomu Sato Koji Miyanishi Yasushi Sato Rishu Takimoto Masayoshi Kobune Atsushi Miyamoto Tomoko Sonoda Junji Kato Department of Medical Oncology and Hematology Sapporo Medical University School of MedicineSapporo 0600061Japan Department of Hospital Pharmacy Sapporo Medical University School of MedicineSapporo 0600061Japan Department of Public Health Sapporo Medical University School of MedicineSapporo 0600061Japan

AIM: To investigate the effectiveness of phenol for the relief of cancer pain by endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN).

关键词： celiac plexus neurolysis celiac plexus blockade Endoscopic ultrasound Phenol Pain management Upper gastrointestinal cancer

Predictors of pain response after endoscopic ultrasound-guided celiac plexus neurolysis for abdominal pain caused by pancreatic malignancy

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World Journal of Gastroenterology 2021年第1期27卷 69-79页

作者： Chao-Qun Han Xue-Lian Tang Qin Zhang Chi Nie Jun Liu Zhen Ding Division of Gastroenterology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022Hubei ProvinceChina

BACKGROUND Endoscopic ultrasound-guided celiac plexus neurolysis(EUS-CPN)has gained popularity as a minimally invasive approach and is currently widely used to treat pancreatic cancer-associated ***,response to treatment is *** To identify the efficacy of EUS-CPN and explore determinants of pain response in EUS-CPN for pancreatic cancer-associated *** A retrospective study of 58 patients with abdominal pain due to inoperable pancreatic cancer who underwent EUS-CPN were *** efficacy for palliation of pain was evaluated based on the visual analog scale pain score at 1 wk and 4 wk after *** and multivariable logistic regression analyses were performed to explore predictors of pain *** A good pain response was obtained in 74.1%and 67.2%of patients at 1 wk and 4 wk,*** located in the body/tail of the pancreas and patients receiving bilateral treatment were weakly associated with a good *** analysis revealed patients with invisible ganglia and metastatic disease were significant factors for a negative response to EUS-CPN at 1 wk and 4 wk,respectively,particularly for invasion of the celiac plexus(odds ratio(OR)=13.20,P=0.003 for 1 wk and OR=15.11,P=0.001 for 4 wk).No severe adverse events were *** EUS-CPN is a safe and effective form of treatment for intractable pancreatic cancer-associated *** ganglia,distant metastasis,and invasion of the celiac plexus were predictors of less effective response in EUS-CPN for pancreatic cancer-related *** these patients,efficacy warrants attention.

关键词： Endoscopic ultrasound celiac plexus neurolysis Pancreatic cancer Pain Predictor

Endoscopic ultrasonography-guided celiac plexus neurolysis in patients with unresectable pancreatic cancer: An update

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World Journal of Gastrointestinal Endoscopy 2021年第10期13卷 460-472页

作者： Guillermo Pérez-Aguado Diego Martinez-Acitores de la Mata Carlos Marra-López Valenciano Ignacio Fernandez-Urien Sainz Department of Gastroenterology Complejo Hospitalario Insular Materno Infantil de Gran CanariaLas Palmas de Gran CanariaLas Palmas 35016Spain Department of Gastroenterology Endoscopy UnitComplejo Hospitalario de Navarra CHNPamplona Navarra 31008Spain Department of Gastroenterology Endoscopy UnitAgencia Sanitaria Costa del SolMálaga 29603Spain

Pancreatic cancer produces disabling abdominal pain,and the pain medical management for pancreatic cancer is often challenging because it mainly relies on the use of narcotics(major opioids).However,opioids often provide suboptimal pain relief,and the use of opioids can lead to patient tolerance and several side effects that considerably reduce the quality of life of pancreatic cancer ***-guided celiac plexus neurolysis(EUS-CPN)is an alternative for pain control in patients with nonsurgical pancreatic cancer;EUS-CPN consists of the injection of alcohol and a local anesthetic into the area of the celiac plexus to achieve chemical ablation of the nerve ***-CPN via the transgastric approach is a safer and more accessible technique than the percutaneous *** have reviewed most of the studies that evaluate the efficacy of EUSCPN and that have compared the different approaches that have been performed by *** efficacy of EUS-CPN varies from 50%to 94%in the different studies,and EUS-CPN has a pain relief duration of 4–8 *** factors are involved in its efficacy,such as the onset of pain,previous use of chemotherapy,presence of metastatic disease,EUS-CPN technique,type of needle or neurolytic agent used,*** to this review,injection into the ganglia may be the best technique,and a good visualization of the ganglia is the best predictor for a good EUS-CPN response,although more studies are ***,any of the 4 different techniques could be used to perform EUS-CPN effectively with no differences in terms of complications between the techniques,but more studies are *** effect of EUS-CPN on pain improvement,patient survival and patient quality of life should be evaluated in well-designed randomized clinical *** research also needs to be performed to clarify the best time frame in performing a EUS-CPN.

关键词： Pancreatic cancer Endosonography celiac plexus neurolysis Opioids Echoendoscopy

Endoscopic ultrasound-guided treatments: Are we getting evidence based- a systematic review

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World Journal of Gastroenterology 2014年第26期20卷 8424-8448页

作者： Carlo Fabbri Carmelo Luigiano Andrea Lisotti Vincenzo Cennamo Clara Virgilio Giancarlo Caletti Pietro Fusaroli Unit of Gastroenterology and Digestive Endoscopy AUSL Bologna Bellaria-Maggiore Hospital Unit of Gastroenterology and Digestive Endoscopy Department of Medical and Surgical Sciences - DIMEC University of BolognaHospital S Maria della Scaletta

The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound(EUS)-guided *** include EUS-guided drainage of pancreatic fluid collections,EUS-guided necrosectomy,EUS-guided cholangiography and biliary drainage,EUSguided pancreatography and pancreatic duct drainage,EUS-guided gallbladder drainage,EUS-guided drainage of abdominal and pelvic fluid collections,EUS-guided celiac plexus block and celiac plexus neurolysis,EUSguided pancreatic cyst ablation,EUS-guided vascular interventions,EUS-guided delivery of antitumoral agents and EUS-guided fiducial placement and *** these procedures are technically challenging and require expertise in both EUS and interventional endoscopy,such as endoscopic retrograde cholangiopancreatography and gastrointestinal *** undertook a systematic review to record the entire body of literature accumulated over the past 2decades on EUS-guided interventions with the objective of performing a critical appraisal of published articles,based on the classification of studies according to levels of evidence,in order to assess the scientific progress made in this field.

关键词： Endoscopic ultrasound Pseudocyst drainage Necrosectomy celiac plexus neurolysis Levels of evidence Fine needle injection

Advanced Endoscopic Palliation of Unresectable Periampullary Carcinoma: A Systematic Review

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Open Journal of Gastroenterology 2022年第10期12卷 249-262页

作者： Shailesh Simkhada Shravana Aryal Albert D. Osei Ashik Pokharel Rami Matar Michael Maitar Springfield Memorial Hospital Springfield Illinois USA Southern Illinois University Springfield Illinois USA Medstar Health Internal Medicine Baltimore Maryland USA St. George’s University West Indies Grenada

Background and Aims: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Though they require multispecialty support;role of endoscopic interventions in palliation is paramount because of the advancement in technology and increase experience of Gastroenterologist. Methods: We did extensive review of articles regarding endoscopic advances in the management of Unresectable Periampullary Malignancies. Several systematic reviews, Meta analysis, and Randomized controlled trials published over the last 2 decades were thoroughly searched on PUBMED and GOOGLE SCHOLAR. Results: Advanced Endoscopic procedures have been emerging as a superior modality than conventional measures because of minimal invasiveness and greater clinical and technical success. Conclusion: Periampullary malignancies often present at an advanced unresectable stage requiring palliation of symptoms for the better quality of life. Several endoscopic interventions have already been established as the standard of care in palliation of symptoms of unresectable periampullary malignancies, we can say with confidence that with growing advances in EUS, advancement in technologies and increasing experiences, the role of gastroenterologist will be pivotal in these groups of patients.

关键词： Periampullary Malignancies Endoscopic Ultrasound celiac plexus neurolysis ERCP EUS-BD EUS-GE

Current role of endoscopic ultrasound in the diagnosis and management of pancreatic cancer

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World Journal of Gastrointestinal Endoscopy 2022年第1期14卷 35-48页

作者： Federico Salom Frédéric Prat Department of Gastroenterology Hospital MexicoUruca 1641-2050San JoseCosta Rica Servide d'Endoscopie Hopital BeaujonUniversitéParis et INSERM U1016Clichy 92118ParisFrance

Endoscopic ultrasound(EUS)has emerged as an invaluable tool for the diagnosis,staging and treatment of pancreatic ductal adenocarcinoma(PDAC).EUS is currently the most sensitive imaging tool for the detection of solid pancreatic *** EUS has evolved,and new imaging techniques,such as contrast-enhanced harmonics and elastography,have been developed to improve diagnostic accuracy during the evaluation of focal pancreatic *** recently,evaluation with artificial intelligence has shown promising results to overcome operator-related flaws during EUS imaging ***,an appropriate diagnosis is based on a proper histological assessment,and EUSguided tissue acquisition is the standard procedure for pancreatic *** developed cutting needles with core tissue procurement provide the possibility of molecular evaluation for personalized oncological *** EUS has modified the therapeutic approach,primarily for advanced pancreatic ***-guided fiducial placement for local targeted radiotherapy treatment or EUS-guided radiofrequency ablation has been developed for local treatment,especially for patients with pancreatic cancer not suitable for surgical ***,EUS-guided therapeutic procedures,such as celiac plexus neurolysis for pain control and EUS-guided biliary drainage for biliary obstruction,have dramatically improved in recent years toward a more effective and less invasive procedure to palliate complications related to *** the current benefits of EUS in the diagnosis and management of PDAC will be thoroughly discussed.

关键词： Endoscopic ultrasound Contrast-enhanced harmonic Elastography Artificial intelligence Radiofrequency ablation celiac plexus neurolysis Biliary drainage