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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 pain.However,response to treatment is variable.AIM To identify the efficacy of EUS-CPN and explore determinants of pain response in EUS-CPN for pancreatic cancer-associated pain.METHODS A retrospective study of 58 patients with abdominal pain due to inoperable pancreatic cancer who underwent EUS-CPN were included.The efficacy for palliation of pain was evaluated based on the visual analog scale pain score at 1 wk and 4 wk after EUS-CPN.Univariable and multivariable logistic regression analyses were performed to explore predictors of pain response.RESULTS A good pain response was obtained in 74.1%and 67.2%of patients at 1 wk and 4 wk,respectively.Tumors located in the body/tail of the pancreas and patients receiving bilateral treatment were weakly associated with a good outcome.Multivariate 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 reported.CONCLUSION EUS-CPN is a safe and effective form of treatment for intractable pancreatic cancer-associated pain.Invisible ganglia,distant metastasis,and invasion of the celiac plexus were predictors of less effective response in EUS-CPN for pancreatic cancer-related pain.For 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 patients.Endosonography-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 tissue.EUS-CPN via the transgastric approach is a safer and more accessible technique than the percutaneous approach.We have reviewed most of the studies that evaluate the efficacy of EUSCPN and that have compared the different approaches that have been performed by endosonographers.The efficacy of EUS-CPN varies from 50%to 94%in the different studies,and EUS-CPN has a pain relief duration of 4–8 wk.Several 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,etc.According 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 needed.However,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 needed.The effect of EUS-CPN on pain improvement,patient survival and patient quality of life should be evaluated in well-designed randomized clinical trials.Further 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

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 tumors.Conventional 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 lesions.More recently,evaluation with artificial intelligence has shown promising results to overcome operator-related flaws during EUS imaging evaluation.Currently,an appropriate diagnosis is based on a proper histological assessment,and EUSguided tissue acquisition is the standard procedure for pancreatic sampling.Newly developed cutting needles with core tissue procurement provide the possibility of molecular evaluation for personalized oncological treatment.Interventional EUS has modified the therapeutic approach,primarily for advanced pancreatic cancer.EUS-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 resection.Additionally,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 PDAC.All 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

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